国家趋势和机器人手术方法在炎症性肠病患者管理中的可行性。
National trends and feasibility of a robotic surgical approach in the management of patients with inflammatory bowel disease.
机构信息
Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Medicine, National Capital Region, 10215 Fernwood Road, Suite 630, Bethesda, MD, 20817, USA.
出版信息
Surg Endosc. 2023 Oct;37(10):7849-7858. doi: 10.1007/s00464-023-10333-1. Epub 2023 Aug 24.
BACKGROUND
Research on the utilization of robotic surgical approaches in the management of inflammatory bowel disease (IBD) is limited. The aims of this study were to identify temporal trends in robotic utilization and compare the safety of a robotic to laparoscopic operative approach in patients with IBD.
METHODS
Patients who underwent minimally invasive surgery (MIS) for IBD were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2013-2021). Temporal trends of robotic utilization were assessed from 2013 to 2021. Primary (30-day overall and serious morbidity) and secondary (unplanned conversion to open) outcomes were assessed between 2019 and 2021, when robotic utilization was highest. Multivariable logistic regression was performed.
RESULTS
The use of a robotic approach for colectomies and proctectomies increased significantly between 2013 and 2021 (p < 0.001), regardless of disease type. A total of 6016 patients underwent MIS for IBD between 2019 and 2021. 2234 (37%) patients had surgery for UC [robotic 430 (19.3%), lap 1804 (80%)] and 3782 (63%) had surgery for CD [robotic 500 (13.2%), lap 3282 (86.8%)]. For patients with UC, there was no difference in rates of overall morbidity (22.6% vs. 20.7%, p = 0.39), serious morbidity (11.4% vs. 12.3%, p = 0.60) or conversion to open (1.5% vs. 2.1%, p = 0.38) between the laparoscopic and robotic approaches, respectively. There was no difference in overall morbidity between the two groups in patients with CD (lap 14.0% vs robotic 16.4%, p = 0.15), however the robotic group exhibited higher rates of serious morbidity (7.3% vs. 11.2%, p < 0.01), shorter LOS (3 vs. 4 days, p < 0.001) and lower rates of conversion to an open procedure (3.8% vs. 1.6%, p = 0.02). Adjusted analysis showed similar results.
CONCLUSION
The use of the robotic platform in the surgical management of IBD is increasing and is not associated with an increase in 30-day overall morbidity compared to a laparoscopic approach.
背景
目前针对机器人手术在炎症性肠病（IBD）管理中的应用的研究有限。本研究旨在确定机器人应用的时间趋势，并比较 IBD 患者机器人手术与腹腔镜手术的安全性。
方法
使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2013-2021 年），识别接受微创外科手术（MIS）治疗 IBD 的患者。从 2013 年至 2021 年评估机器人应用的时间趋势。2019 年至 2021 年，当机器人使用率最高时，评估主要（30 天总体和严重发病率）和次要（意外转为开放）结局。进行多变量逻辑回归。
结果
2013 年至 2021 年，无论疾病类型如何， colectomies 和 proctectomies 的机器人手术使用率均显著增加（p<0.001）。2019 年至 2021 年，共有 6016 名患者接受 MIS 治疗 IBD。2234 名（37%）患者接受 UC 手术[机器人 430（19.3%），腹腔镜 1804（80%）]，3782 名（63%）患者接受 CD 手术[机器人 500（13.2%），腹腔镜 3282（86.8%）]。对于 UC 患者，腹腔镜和机器人手术的总体发病率（22.6% vs. 20.7%，p=0.39）、严重发病率（11.4% vs. 12.3%，p=0.60）或转为开放手术的发生率（1.5% vs. 2.1%，p=0.38）之间没有差异。在 CD 患者中，两组之间的总体发病率没有差异（腹腔镜 14.0% vs. 机器人 16.4%，p=0.15），但机器人组的严重发病率较高（7.3% vs. 11.2%，p<0.01）， LOS 更短（3 天 vs. 4 天，p<0.001），转为开放手术的比例较低（3.8% vs. 1.6%，p=0.02）。调整分析得到了类似的结果。
结论
与腹腔镜方法相比，机器人平台在 IBD 的外科治疗中的应用增加，但与 30 天总体发病率增加无关。
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