Sanderfer V Christian, Jensen Stephanie, Qadri Hisham I, Yang Hongmei, Benham Emily C, Lauer Cynthia, Muir Kathryn, Thomas Bradley W, Clemens Michael S, Maloney Sean R, Sherrill William C, May Addison K, Ross Samuel W
Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, 1000 Blythe Blvd, CharlotteCharlotte, NC, 28203, USA.
Wake Forest School of Medicine, Academic Medical Education, Winston-Salem, NC, USA.
Surg Endosc. 2025 Jan;39(1):472-479. doi: 10.1007/s00464-024-11266-z. Epub 2024 Oct 14.
Acute Care Surgery (ACS) admissions and procedures are substantially increasing. ACS disproportionally accounts for a majority of morbidity and mortality among surgical patients. Minimally invasive techniques are associated with improved outcomes and shorter hospital length of stay within the ACS population. While laparoscopy is widespread, ACS surgeons have been slower to adopt the use of robotics. We aimed to evaluate the feasibility of incorporating robotic surgery within ACS practice.
Robotic General Surgery operations performed by 8 Acute Care Surgeons from 5 local facilities within a large integrated healthcare system were queried over a 15 month period. Patients who underwent emergent, urgent, sub-acute, and elective robotic operations by ACS staff were identified. Demographics collected included age, gender, BMI, and ASA score. Outcomes recorded included procedure classification, total supply and implant charges (TSI), conversion to open, hospital length of stay (LOS), 30 day readmission, and 30 day mortality.
Of 200 operations, the most common were Cholecystectomy (43.5%), Inguinal hernia repair (26.0%), Ventral hernia repair (18.0%), Appendectomy (5.0%), and Sigmoid Colectomy (3.5%). The median (± std dev) age was 48 ± 16.66 years and BMI was 29.9 ± 8.79 kg/m. 46% of cases were sub-acute (n = 92), 33.5% were elective (n = 67), 14% were emergent (n = 28), and 6.5% were urgent (n = 13). Most patients were ASA 2 (107, 46.1%) or ASA 3 (71, 45.9%). The median (IQR) TSI and LOS were $1,770 (889.50) USD and 0.1 (0.9) days. Forty-one inpatient procedures were performed. Median LOS was 3 days and expected LOS was 3.1 days (O:E = 0.96). Five patients were readmitted within 30 days, and there were no deaths within 30 days.
Robotic techniques may be safely implemented by ACS surgeons, potentially benefitting both patient and surgeon. LOS was similar between laparoscopic and robotic cases and only two cases required conversion to an open procedure. Next steps include a multi-center prospective trial comparing robotic to laparoscopic cases.
急性护理手术（ACS）的入院人数和手术量在大幅增加。ACS在外科患者的发病率和死亡率中占比过高。微创技术与ACS人群中更好的治疗效果和更短的住院时间相关。虽然腹腔镜检查已广泛应用，但ACS外科医生采用机器人技术的速度较慢。我们旨在评估在ACS实践中纳入机器人手术的可行性。
查询了一个大型综合医疗系统中5家当地机构的8名急性护理外科医生在15个月内进行的机器人普通外科手术。确定了由ACS工作人员进行紧急、加急、亚急性和择期机器人手术的患者。收集的人口统计学数据包括年龄、性别、体重指数（BMI）和美国麻醉医师协会（ASA）评分。记录的结果包括手术分类、总供应和植入费用（TSI）、转为开放手术、住院时间（LOS）、30天再入院率和30天死亡率。
在200例手术中，最常见的是胆囊切除术（43.5%）、腹股沟疝修补术（26.0%）、腹疝修补术（18.0%）、阑尾切除术（5.0%）和乙状结肠切除术（3.5%）。年龄中位数（±标准差）为48±16.66岁，BMI为29.9±8.79kg/m²。46%的病例为亚急性（n = 92），33.5%为择期（n = 67），14%为紧急（n = 28），6.5%为加急（n = 13）。大多数患者为ASA 2级（107例，46.1%）或ASA 3级（71例，45.9%）。TSI和LOS的中位数（四分位间距）分别为1770（889.50）美元和0.1（0.9）天。共进行了41例住院手术。中位住院时间为3天，预期住院时间为3.1天（实际值：预期值 = 0.96）。5例患者在30天内再次入院，30天内无死亡病例。
ACS外科医生可以安全地实施机器人技术，这可能对患者和外科医生都有益。腹腔镜手术和机器人手术的住院时间相似，只有两例需要转为开放手术。下一步包括一项比较机器人手术和腹腔镜手术的多中心前瞻性试验。
