Kumamoto Tsutomu, Otsuka Koki, Hiro Junichiro, Taniguchi Hiroko, Cheong Yeongcheol, Omura Yusuke, Inaguma Gaku, Kobayashi Yosuke, Kamishima Megumu, Tsujimura Kazuki, Chikaishi Yuko, Masumori Koji, Uyama Ichiro, Suda Koichi
Department of Surgery, Fujita Health University, Toyoake, Japan.
Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan.
Surg Endosc. 2025 Jan;39(1):229-236. doi: 10.1007/s00464-024-11362-0. Epub 2024 Nov 4.
In the field of abdominal surgery, including colorectal cancer surgery, robotic surgery has become widespread, and the introduction of new robotic platforms is increasing. As a result, the incidence of subcutaneous emphysema (SE) as a postoperative complication has increased; however, the causes, grade, and perioperative course of SE have not been definitively examined. Therefore, we aimed to evaluate potential risk factors of SE after robotic colorectal cancer surgery.
Between November 2022 and March 2024, 244 consecutive patients who underwent robotic colorectal cancer surgery using the da Vinci Xi (n = 190) or the hinotori™ platform (n = 54) were retrospectively analyzed. Risk factors associated with postoperative SE were assessed by multivariate analysis using logistic regression models. Moreover, the grade of SE and its perioperative course were investigated based on the two robotic platforms.
Postoperative SE was observed in 95 patients (38.9%). Nine patients (3.7%) had severe SE. The risk factors for SE were female sex, older age (≥ 80 years), and maximum intraabdominal pressure (max IAP) with CO insufflation > 10 mmHg (odds ratio [95% confidence interval]: 1.981 [1.105-3.552], p = 0.022; 2.765 [1.310-5.835], p = 0.008; and 13.249 [1.227-143.020], p = 0.033, respectively). Additionally, the incidence of SE when using the hinotori™ platform was significantly lower than when using the da Vinci Xi platform (0.302 [0.135-0.667], p = 0.004).
Max IAP with CO > 10 mmHg was associated with SE during robotic colorectal cancer surgery. Compared with the use of da Vinci Xi, the use of hinotori™ was associated with fewer incidences of postoperative SE, especially in females and older patients (≥ 80 years).
在包括结直肠癌手术在内的腹部外科领域，机器人手术已广泛应用，新的机器人平台也不断引入。因此，皮下气肿（SE）作为术后并发症的发生率有所增加；然而，SE的病因、分级及围手术期过程尚未得到明确研究。因此，我们旨在评估机器人辅助结直肠癌手术后SE的潜在危险因素。
回顾性分析2022年11月至2024年3月期间连续接受使用达芬奇Xi（n = 190）或日之丸™平台（n = 54）进行机器人辅助结直肠癌手术的244例患者。使用逻辑回归模型通过多变量分析评估与术后SE相关的危险因素。此外，基于这两个机器人平台研究了SE的分级及其围手术期过程。
95例患者（38.9%）出现术后SE。9例患者（3.7%）出现严重SE。SE的危险因素为女性、高龄（≥80岁）以及二氧化碳气腹时的最大腹内压（max IAP）>10 mmHg（比值比[95%置信区间]：1.981[1.105 - 3.552]，p = 0.022；2.765[1.310 - 5.835]，p = 0.008；以及13.249[1.227 - 143.020]，p = 0.033）。此外，使用日之丸™平台时SE的发生率显著低于使用达芬奇Xi平台时（0.302[0.135 - 0.667]，p = 0.004）。
机器人辅助结直肠癌手术期间，二氧化碳气腹时max IAP>10 mmHg与SE相关。与使用达芬奇Xi相比，使用日之丸™术后SE的发生率较低，尤其是在女性和高龄（≥80岁）患者中。
