Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA.
J Robot Surg. 2024 Mar 30;18(1):142. doi: 10.1007/s11701-024-01909-7.
To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias.
From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively collected. We studied hernias potentially suitable for robotic repair: elective, midline, 3-10 cm rectus separation, no prior mesh, and no need for concomitant procedure. Robotic or open repair was performed by surgeon or patient preference. The primary outcome was any complication using Clavien-Dindo scoring. Secondary outcomes were operative time, length-of-stay, and readmissions. Regression identified predictors of complications.
Of 648 hernias repaired, 70 robotic and 52 open repairs met inclusion criteria. The groups had similar patient demographics, co-morbidities, and hernia size, except that there were more immunosuppressed patients in the open group (11 versus 5 patients, p = 0.031). Complications occurred after 7 (13%) open repairs versus 2 (3%) robotic repairs, p = 0.036. Surgical site infection occurred after four open repairs but no robotic repair, p = 0.004. Length-of-stay averaged almost 3 days longer after open repair (4.3 ± 2.7 days versus 1.5 ± 1.4 days, p = 0.031). Readmission occurred after 6 (12%) oppen repairs but only 1 (1%) robotic repair. A long-term survey (61% response rate after mean follow-up of 2.8 years) showed that the HerQLes QOL score was better after robotic repair (46 ± 15 versus 40 ± 17, = 0.049). In regression models, only open technique predicted complications.
Robotic techniques were associated with fewer complications, shorter hospitalization, fewer infections, and fewer readmissions compared to open techniques. Open surgical technique was the only predictor of complications.
比较机器人与开放式修复术治疗单纯、中等大小、中线腹疝的结果。
2017 年至 2021 年，前瞻性收集我院所有腹疝患者的特征和 30 天结果。我们研究了适合机器人修复的疝：择期、中线、3-10cm 直肌分离、无先前补片和无需同时进行其他手术。机器人或开放式修复由外科医生或患者选择。主要结局为使用 Clavien-Dindo 评分的任何并发症。次要结局为手术时间、住院时间和再入院。回归分析确定并发症的预测因素。
648 例疝修补中，70 例机器人修补和 52 例开放式修补符合纳入标准。两组患者的人口统计学、合并症和疝大小相似，但开放式组的免疫抑制患者更多（11 例比 5 例，p=0.031）。开放式组有 7 例（13%）发生并发症，机器人组有 2 例（3%），p=0.036。4 例开放式组发生手术部位感染，无机器人组，p=0.004。开放式组住院时间平均长近 3 天（4.3±2.7 天比 1.5±1.4 天，p=0.031）。开放式组有 6 例（12%）再入院，机器人组有 1 例（1%）。长期调查（平均随访 2.8 年后的响应率为 61%）显示，机器人组的 HerQLes QOL 评分更好（46±15 比 40±17，p=0.049）。回归模型中，只有开放式技术预测并发症。
与开放式技术相比，机器人技术具有更少的并发症、更短的住院时间、更少的感染和更少的再入院。开放式手术技术是并发症的唯一预测因素。
