Department of Surgery, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, 300 Gumi-Dong, Bundang-gu, Seongnam-si, 13620, Gyenggi-do, Korea.
Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Sci Rep. 2023 Oct 13;13(1):17384. doi: 10.1038/s41598-023-44305-1.
Advancements in minimally invasive surgery has led to the development of several surgical instruments, including the ArtiSential®. This new instrument provides a greater range of motion and improved dexterity to laparoscopic procedures, making it an alternative option to traditional straight instruments, and the Da Vinci robot system. The purpose of this study is to compare the postoperative outcomes of a prospective cohort of patients who underwent laparoscopic gastrectomy using articulating instruments with those of a historical cohort of patients who underwent the same procedure using straight instruments. The study was designed as a prospective observational cohort study matched to a retrospective historical cohort using propensity score matching. The primary outcome was the rate of early complications within 90 days of surgery. Other outcomes included the operation time, estimated blood loss, time to first flatus, time to first soft fluid diet, hospital stay, and mortality. After propensity score matching, 41 patients were enrolled in both groups. The mean age was 62.4 ± 12.3 years in the conventional group and 63.5 ± 9.6 years in the artisential group (p = 0.647). Mean operative time was significantly shorter in the artisential group compared to the conventional group (136.1 min vs. 163.9 min, p = 0.032). The time to first soft fluid diet was also significantly shorter in the artisential group (2.2 days vs. 2.8 days, p = 0.030), but there was no significant difference in the time to first flatus and overall hospital stay. The incidence of early complications was lower in the artisential group, but the difference was not significant (24.4% vs 7.3%, p = 0.070). There was no mortality in either group. The use of articulating instruments for laparoscopic gastrectomy did not increase postoperative morbidity compared to straight laparoscopic instruments. The use of articulating instruments may be associated with faster bowel recovery and less early complications.
微创技术的进步催生了多种手术器械，其中包括 ArtiSential®。这种新型器械为腹腔镜手术提供了更大的运动范围和更高的灵巧性，成为传统直式器械和达芬奇机器人系统的替代选择。本研究旨在比较使用铰接器械进行腹腔镜胃切除术的前瞻性队列患者与使用直式器械进行同一手术的历史队列患者的术后结果。该研究设计为前瞻性观察队列研究，通过倾向评分匹配与回顾性历史队列研究相匹配。主要结果是术后 90 天内的早期并发症发生率。其他结果包括手术时间、估计出血量、首次排气时间、首次软食时间、住院时间和死亡率。在进行倾向评分匹配后，两组各有 41 名患者入组。常规组的平均年龄为 62.4±12.3 岁，ArtiSential 组为 63.5±9.6 岁（p=0.647）。与常规组相比，ArtiSential 组的平均手术时间明显缩短（136.1 分钟 vs. 163.9 分钟，p=0.032）。首次软食时间也明显缩短（2.2 天 vs. 2.8 天，p=0.030），但首次排气时间和总住院时间无显著差异。ArtiSential 组的早期并发症发生率较低，但差异无统计学意义（24.4% vs. 7.3%，p=0.070）。两组均无死亡病例。与直式腹腔镜器械相比，使用铰接器械进行腹腔镜胃切除术并未增加术后发病率。使用铰接器械可能与更快的肠道恢复和更少的早期并发症相关。
