Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida.
Surg Obes Relat Dis. 2024 Sep;20(9):831-839. doi: 10.1016/j.soard.2024.03.017. Epub 2024 Mar 25.
Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident.
Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021.
Academic institution.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample.
Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15, P = .0463), postoperative morbidity (OR 1.07; 95% CI 1.01-1.12, P = .0193), readmission (OR 1.14; 95% CI 1.09-1.18, P < .0001), and emergency department visits (OR 1.06; 95% CI 1.03-1.09, P = .0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases.
Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy.
机器人手术在减重代谢手术中越来越受欢迎。然而，与传统腹腔镜手术相比，其术后效果的优势尚未得到明确证实。随着机器人手术的广泛采用和技术的不断改进，其益处应该会更加明显。
评估 2015 年至 2021 年间，常规腹腔镜手术与机器人辅助手术治疗减重代谢手术后的再入院和再次手术率。
学术机构。
对接受常规腹腔镜手术与机器人辅助手术的减重代谢手术的代谢和减重手术认证和质量改进计划（MBSAQIP）进行了回顾。在倾向评分匹配的样本中比较了术后结果。
在符合纳入标准的 1,059,348 例患者中，921,322 例（87%）为常规腹腔镜减重代谢手术，与机器人辅助手术病例 1:1 匹配（138,026 例）。再次手术（比值比 [OR] 1.07；95%置信区间 [CI] 1.00-1.15，P =.0463）、术后发病率（OR 1.07；95% CI 1.01-1.12，P =.0193）、30 天内再入院（OR 1.14；95% CI 1.09-1.18，P <.0001）和急诊就诊（OR 1.06；95% CI 1.03-1.09，P =.0003）的发生率明显高于机器人辅助手术病例。与常规腹腔镜病例相比，机器人辅助手术病例的 30 天内死亡率和住院时间>3 天的发生率相似。在 2020 年至 2021 年期间的病例中也观察到了类似的结果，但再次手术和急诊就诊的发生率没有差异，而住院时间>3 天的发生率在机器人辅助手术病例中更高。
我们的结果表明，与常规腹腔镜手术相比，机器人辅助减重代谢手术的术后 30 天内再入院和再次手术率更高，发病率更高。仅分析 2020 年至 2021 年期间的病例，机器人手术也没有优于传统腹腔镜手术。
