Alnumay Abdulaziz
Department of Surgery, Division of General Surgery, King Saud University, 3332, 8108, 12372, Riyadh, Saudi Arabia.
J Robot Surg. 2024 Jul 13;18(1):283. doi: 10.1007/s11701-024-02044-z.
The robotic approach improves the feasibility of minimally invasive colectomy even where there may be an anatomic challenge with laparoscopy. Whether a failure in completing colectomy with this newer technology is associated with worse consequences needs to be considered when evaluating the relative benefit of robotic colectomy. The aim of this study is to evaluate rates of conversion to open surgery after robotic and laparoscopic colectomy and whether outcomes after conversion vary after the two techniques since this has not been well studied. From the American College of Surgeons (ACS) - National Surgical Quality Improvement Program (NSQIP) (2015-2016), patients who underwent elective minimally invasive colectomy were identified. Converted robotic were compared to laparoscopic procedures for patient demographics, co-morbidities; primary procedure and diagnosis, prolonged operation and postoperative complications. Of 36,046 colectomy procedures, 30,808 (85.5%) were laparoscopic, while 5238 (14.5%) were robotic-assisted. There were 3271 (9.1%) conversions to open surgery (laparoscopic: 2959 [9.6%]; robotic: 312 [6%]). Thirty-day postoperative surgical site infection, anastomotic leak, ileus, sepsis, bleeding requiring transfusion, urinary tract infection, reoperation; pulmonary, renal, cardiac/cerebrovascular complications; readmission, hospital stay, and mortality, were similar between the two groups. However, deep vein thrombosis/pulmonary embolism was higher after robotic conversion (4.5% vs. 2.2%, p = 0.01). Conversion was lower after robotic when compared to laparoscopic colectomy. Converted patients had similar outcomes except for vein thromboembolism which was higher after robotic surgery. Robotic technology seems to improve the feasibility of minimally invasive surgery without negatively affecting safety and efficacy even when conversion is required.
即使在腹腔镜手术可能面临解剖学挑战的情况下，机器人手术方法也提高了微创结肠切除术的可行性。在评估机器人结肠切除术的相对益处时，需要考虑使用这种新技术完成结肠切除术失败是否会带来更严重的后果。本研究的目的是评估机器人结肠切除术和腹腔镜结肠切除术后转为开放手术的发生率，以及两种技术转为开放手术后的结果是否不同，因为这方面尚未得到充分研究。从美国外科医师学会（ACS）-国家外科质量改进计划（NSQIP）（2015 - 2016年）中，识别出接受择期微创结肠切除术的患者。将转为机器人手术的患者与腹腔镜手术患者在人口统计学、合并症、主要手术和诊断、手术时间延长及术后并发症方面进行比较。在36046例结肠切除术中，30808例（85.5%）为腹腔镜手术，而5238例（14.5%）为机器人辅助手术。有3271例（9.1%）转为开放手术（腹腔镜手术：2959例[9.6%]；机器人手术：312例[6%]）。两组患者术后30天的手术部位感染、吻合口漏、肠梗阻、败血症、需要输血的出血、尿路感染、再次手术、肺部、肾脏、心脏/脑血管并发症、再次入院、住院时间和死亡率相似。然而，机器人手术转为开放手术后深静脉血栓形成/肺栓塞的发生率更高（4.5%对2.2%，p = 0.01）。与腹腔镜结肠切除术相比，机器人手术转为开放手术的发生率更低。除静脉血栓栓塞在机器人手术后更高外，转为开放手术的患者有相似的结果。即使需要转为开放手术，机器人技术似乎也能提高微创手术的可行性，且不会对安全性和疗效产生负面影响。
