Ross Sharona B, Dugan Michelle M, Sucandy Iswanto, Christodoulou Maria, Pattilachan Tara Menon, Saravanan Sneha, Rayman Shlomi, Jacoby Harel, Rosemurgy Alexander
Foregut and HPB Division, Digestive Health Institute AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA.
Department of General Surgery, Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL, USA.
J Robot Surg. 2024 Dec 16;19(1):27. doi: 10.1007/s11701-024-02189-x.
Robotic platforms are increasingly utilized in surgery, offering unique technical advantages, though there is a scarcity of difficulty scoring systems (DSS) for these procedures. DSS aids in understanding operative complexities and enhancing preoperative planning. With IRB approval, data were collected on 200 consecutive adult patients who underwent robotic pancreaticoduodenectomy at a high-volume institution from 2019 to 2022. Linear regression was employed on clinical variables to analyze operative time and estimated blood loss as markers of surgical complexity. Weighted scoring system was developed using significant linear coefficient values, and an ANOVA analysis created the difficulty-level grouping system. Significant variables affecting operative time and/or EBL included: history of alcoholism, preoperative endoscopic intervention, tumor size, nodal disease on preoperative imaging, pancreatic duct dilation. These factors created the DSS ranging from 0 to 33. Group 1 (0-8, n = 9), Group 2 (9-20, n = 145), Group 3 (21-26, n = 37), and Group 4 (27-33, n = 9) showed significant differences in age, history of alcoholism, preoperative jaundice, tumor size, nodal disease, and operative metrics. Our novel DSS for robotic pancreaticoduodenectomy effectively predicts intraoperative challenges and aids in preoperative planning. Future steps include validating the system internally and externally.
机器人平台在手术中的应用越来越广泛,具有独特的技术优势,不过针对这些手术的难度评分系统却很匮乏。难度评分系统有助于了解手术复杂性并加强术前规划。经机构审查委员会(IRB)批准,收集了2019年至2022年期间在一家大型机构接受机器人胰十二指肠切除术的200例连续成年患者的数据。对临床变量进行线性回归分析,以手术时间和估计失血量作为手术复杂性的指标。利用显著线性系数值开发了加权评分系统,并通过方差分析创建了难度等级分组系统。影响手术时间和/或估计失血量的显著变量包括:酗酒史、术前内镜干预、肿瘤大小、术前影像学检查发现的淋巴结疾病、胰管扩张。这些因素形成了范围从0到33的难度评分系统。第1组(0 - 8分,n = 9)、第2组(9 - 20分,n = 145)、第3组(21 - 26分,n = 37)和第4组(27 - 33分,n = 9)在年龄、酗酒史、术前黄疸、肿瘤大小、淋巴结疾病和手术指标方面存在显著差异。我们新的机器人胰十二指肠切除术难度评分系统能有效预测术中挑战并辅助术前规划。未来的步骤包括在内部和外部验证该系统。
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