Spurzem Graham J, Broderick Ryan C, Kunkel Emily K, Hollandsworth Hannah M, Sandler Bryan J, Jacobsen Garth R, Horgan Santiago
Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California.
Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California.
Surg Obes Relat Dis. 2025 Apr;21(4):372-381. doi: 10.1016/j.soard.2024.11.014. Epub 2024 Dec 5.
Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.
Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
United States.
A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables.
A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group.
Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.
机器人辅助减肥手术正在迅速发展。将并发症降至最低的最佳方法仍不明确。
利用代谢与减肥手术认证及质量改进计划（MBSAQIP）数据库，评估机器人的使用情况，并比较腹腔镜和机器人辅助的初次袖状胃切除术（SG）及 Roux-en-Y 胃旁路术（RYGB）的 30 天结局。
美国。
对 MBSAQIP 数据库进行回顾性分析，确定 2015 年至 2022 年的初次 SG 和 RYGB 病例。排除翻修/转换病例、转换为另一种手术方式的病例以及除食管胃十二指肠镜检查外的联合病例。在 1:1 倾向评分匹配后，采用逻辑回归比较结局，以调整患者人口统计学/合并症及手术变量的差异。
共纳入 823,902 例病例（591,118 例 SG；232,784 例 RYGB）。从 2015 年到 2022 年，机器人辅助进行的 SG 和 RYGB 的比例分别从 6.7%和 6.9%增至 29.5%和 31.8%。与腹腔镜手术相比，机器人辅助 SG 的总体并发症发生率显著更高（优势比 1.14 [1.07 - 1.21]，P <.001）、渗漏率（1.24 [1.05 - 1.46]，P =.03）和出血率（1.34 [1.13 - 1.58]，P <.001）。机器人辅助 RYGB 的总体并发症发生率（.75 [.70 -.81]，P <.001）和出血率（.80 [.68 -.94]，P <.01）显著更低，渗漏率相似（.87 [.71 - 1.07]，P =.18）。对于 2020 - 2022 年的病例，机器人辅助 SG 和 RYGB 的联合结局与腹腔镜手术相似，但机器人组的器官/腔隙感染、再入院和感染性休克发生率更高。
与腹腔镜手术相比，机器人辅助 SG 的并发症发生率更高，而机器人辅助 RYGB 可预防出血并发症。机器人手术的短期结局已变得与腹腔镜手术更为相似，但仍较差。有必要进一步研究以阐明导致这些结果的因素。
