Department of Surgery, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan.
Division of Medical Support, Nanpuh Hospital, Kagoshima-city, 892-8512, Japan.
Asian J Surg. 2024 Jun;47(6):2598-2605. doi: 10.1016/j.asjsur.2024.03.086. Epub 2024 Mar 27.
Although robotic surgery is becoming more widespread worldwide, it is still in its infancy. This study aimed to confirm the safety and feasibility of the induction of robotic-assisted gastric surgery at a local hospital.
For five years, between 2016 and 2020, 42 laparoscopic and 71 robotic distal gastrectomies were performed at the same institution. Patients diagnosed with gastric cancer were retrieved from the database. Propensity score matching was performed based on covariates such as Age, Sex, BMI, the American Society of Anesthesiologists Physical Status, Tumor Location, pT, and pN. Clinicopathological characteristics, surgical performance, postoperative outcomes, and pathological data were retrospectively collected and compared by the Chi-square test, the Fisher's exact test, the Student's t-test, and the Mann-Whitney U test.
Billroth II reconstruction was often selected for the robotic group more than the laparoscopic group (59.4% and 15.6%, respectively). In addition, the number of lymph nodes harvested after D2 dissection tended to be more significant in the robotic group than in the laparoscopic group (52.1 ± 7.6 and 29.1 ± 3.7, respectively; p = 0.00934). The mean operative time was 271.4 ± 10.5 min for the robotic group and 220.8 ± 12.3 min for the laparoscopic group (p = 0.00005). There were no differences in short-term clinical outcomes between the two groups.
Although a single-center, small comparative study, the results showed that the robotic surgery group was not inferior to the laparoscopic group in feasibility and safety. Moreover, robotic surgery enables harvesting a higher number of lymph nodes, which may be more advantageous than laparoscopic surgery. This study also showed that as the surgeon gains experience with robotic surgery, its operative time becomes significantly shorter.
尽管机器人手术在全球范围内越来越普及，但它仍处于起步阶段。本研究旨在确认在当地医院进行机器人辅助胃手术的安全性和可行性。
在 2016 年至 2020 年的五年间，同一机构共进行了 42 例腹腔镜和 71 例机器人远端胃切除术。从数据库中检索出诊断为胃癌的患者。根据年龄、性别、BMI、美国麻醉医师协会身体状况、肿瘤位置、pT 和 pN 等协变量进行倾向评分匹配。回顾性收集并比较临床病理特征、手术表现、术后结果和病理数据，采用卡方检验、Fisher 确切检验、学生 t 检验和 Mann-Whitney U 检验。
机器人组比腹腔镜组更常选择 Billroth II 重建（分别为 59.4%和 15.6%）。此外，机器人组 D2 清扫术后淋巴结清扫数量也多于腹腔镜组（分别为 52.1±7.6 和 29.1±3.7；p=0.00934）。机器人组的平均手术时间为 271.4±10.5 分钟，腹腔镜组为 220.8±12.3 分钟（p=0.00005）。两组的短期临床结果无差异。
尽管这是一项单中心、小样本的对比研究，但结果表明机器人手术组在可行性和安全性方面并不逊于腹腔镜组。此外，机器人手术可以采集更多的淋巴结，这可能比腹腔镜手术更有利。本研究还表明，随着外科医生获得机器人手术经验，其手术时间会显著缩短。
