Lin Yucan, Chen Shan, Lin Yang, Zhang Ling, Wang Jianbin, Qiu Xinyi, Xu Di, Li Lizhi
Department of Pediatric Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Department of Laboratory, Fuzhou Second General Hospital, Fuzhou, Fujian, China.
Front Pediatr. 2024 Jun 18;12:1418991. doi: 10.3389/fped.2024.1418991. eCollection 2024.
The purpose of this study is to compare the intraoperative and postoperative outcomes of a trans-umbilical single-site plus one robot-assisted surgery and a trans-umbilical single-site laparoscopic surgery in the treatment of choledochal cysts.
We retrospectively analyzed clinical data from 49 children diagnosed with choledochal cysts who were admitted to our hospital between June 2020 and December 2023. Among these patients, 24 underwent a trans-umbilical single-site plus one Da Vinci robot-assisted surgery (the robot group) and 25 underwent a trans-umbilical single-site laparoscopic-assisted surgery (the laparoscopic group). We compared differences in intraoperative and postoperative outcomes between the two groups.
There was no significant difference between the two groups of patients in terms of gender, age, weight, clinical symptoms, maximum cyst diameter, type, postoperative complications, and facial expression, leg movement, activity, crying, and comfortability (FLACC) scoring ( > 0.05). Compared with the patients in the laparoscopic group, those in the robot group had less intraoperative bleeding [10 (8-12) vs. 15 (11.5-18) ml, < 0.001] and required less postoperative drainage tube indwelling time [5 (4-6) vs. 7 (5.5-8) day, < 0.001], less postoperative fasting time [4 (3-4) vs. 6 (5-7) days, < 0.001], and less postoperative hospitalization time [6 (6-7) vs. 8 (6-10) days, < 0.001], but they required more operative time [385.5 (317.0-413.3) vs. 346.0 (287.0-376.5) min, = 0.050] and consumed more hospitalization expenses (79,323 ± 3,124 vs. 31,121 ± 2,918 yuan, < 0.001).
The results of this study showed a shorter hospitalization time, quicker postoperative recovery, and less tissue damage but a higher cost and a longer operation time in patients who chose robotic surgery rather than laparoscopic surgery. With the continuous expansion of the scale of installed robot-assisted surgical systems and the gradual accumulation of the technical experience of surgeons, robot-assisted surgery may slowly surpass, and shows a trend to replace, laparoscopy because of its advantages.
本研究旨在比较经脐单孔加一机器人辅助手术与经脐单孔腹腔镜手术治疗胆总管囊肿的术中及术后效果。
回顾性分析2020年6月至2023年12月我院收治的49例诊断为胆总管囊肿患儿的临床资料。其中，24例行经脐单孔加一达芬奇机器人辅助手术（机器人组），25例行经脐单孔腹腔镜辅助手术（腹腔镜组）。比较两组术中及术后效果的差异。
两组患者在性别、年龄、体重、临床症状、囊肿最大直径、类型、术后并发症以及面部表情、腿部活动、活动度、哭闹和舒适度（FLACC）评分方面差异均无统计学意义（P＞0.05）。与腹腔镜组患者相比，机器人组患者术中出血量更少[10（8～12）ml对15（11.5～18）ml，P＜0.001]，术后引流管留置时间更短[5（4～6）天对7（5.5～8）天，P＜0.001]，术后禁食时间更短[4（3～4）天对6（5～7）天，P＜0.001]，术后住院时间更短[6（6～7）天对8（6～10）天，P＜0.001]，但手术时间更长[385.5（317.0～413.3）分钟对346.0（287.0～376.5）分钟，P = 0.050]，住院费用更高（79323±3124元对31121±2918元，P＜0.001）。
本研究结果显示，选择机器人手术而非腹腔镜手术的患者住院时间更短、术后恢复更快、组织损伤更小，但费用更高、手术时间更长。随着机器人辅助手术系统装机规模的不断扩大以及外科医生技术经验的逐渐积累，机器人辅助手术因其优势可能会慢慢超越并呈现取代腹腔镜手术的趋势。
