Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, USA.
School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Tech Coloproctol. 2024 Oct 15;28(1):142. doi: 10.1007/s10151-024-02999-z.
Despite advantages for patients with ulcerative colitis, Crohn's disease, and familial adenomatous polyposis, restorative proctocolectomy with ileal pouch-anal anastomosis carries a risk of pouch failure, necessitating pouch excision. The traditional open approach is associated with potential complications. Robotic and laparoscopic techniques are emerging, but comparative outcome data are limited.
We conducted a retrospective study of consecutive adult patients undergoing robotic, laparoscopic, and open ileal pouch excision at Mayo Clinic, Rochester, MN, between January 2015 and December 2023. We analyzed data on patient characteristics, perioperative variables, and postoperative outcomes, focusing on short-term complications. Statistical analysis included appropriate tests.
The study included 123 patients: 23 underwent robotic-assisted pouch excision, 12 laparoscopic, and 82 open. The robotic approach had the longest median operative time (334 ± 170 min, p = 0.03). However, it demonstrated significantly lower estimated blood loss than open (150 ± 200 ml vs. 350 ± 300 ml, p = 0.002) and laparoscopic surgery (250 ± 250 ml, p = 0.005). Robotic and laparoscopic groups required fewer preoperative ureteral stents than the open group (p = 0.001). Additionally, the robotic approach utilized fewer pelvic drainages (p < 0.0001) and had a lower rate of lysis of adhesions > 60 min compared to open surgery (p = 0.003). Robotic procedures had significantly lower 30-day postoperative complications than the open approach (30.4% vs. 65.9%, p = 0.002) while also demonstrating fewer 30-day reoperations than the laparoscopic group (p = 0.04).
Robotic-assisted pouch excision offered significant benefits, including decreased EBL, reduced need for preoperative ureteral stents, and significantly fewer 30-day postoperative complications compared to open surgery.
尽管溃疡性结肠炎、克罗恩病和家族性腺瘤性息肉病患者有优势，但回肠贮袋肛管吻合术的修复性直肠结肠切除术有贮袋失败的风险，需要切除贮袋。传统的开放式方法有潜在的并发症。机器人和腹腔镜技术正在出现，但比较结果数据有限。
我们对 2015 年 1 月至 2023 年 12 月在明尼苏达州罗切斯特市梅奥诊所接受机器人、腹腔镜和开放式回肠贮袋切除术的连续成年患者进行了回顾性研究。我们分析了患者特征、围手术期变量和术后结果的数据，重点关注短期并发症。统计分析包括适当的检验。
该研究纳入了 123 例患者：23 例接受机器人辅助贮袋切除术，12 例接受腹腔镜手术，82 例接受开放式手术。机器人方法的中位手术时间最长（334±170 分钟，p=0.03）。然而，与开放式手术（350±300 毫升，p=0.002）和腹腔镜手术（250±250 毫升，p=0.005）相比，它显示出显著较低的估计失血量。机器人和腹腔镜组比开放式手术组需要更少的术前输尿管支架（p=0.001）。此外，机器人方法使用的盆腔引流管更少（p<0.0001），粘连松解时间超过 60 分钟的发生率低于开放式手术（p=0.003）。机器人手术与开放式手术相比，30 天术后并发症发生率显著降低（30.4%比 65.9%，p=0.002），与腹腔镜组相比，30 天再手术率也更低（p=0.04）。
与开放式手术相比，机器人辅助贮袋切除术具有明显优势，包括减少 EBL、减少术前输尿管支架的需求以及显著降低 30 天术后并发症发生率。
