Eraky Ahmed, Almoflihi Mohammed, Awan Modassar, Jaabou Mohammad, Campistol Miriam, Tillu Neeraja, Choudhary Manish Kumar, Venkatesh Arjun, Kolanukuduru Kaushik P, Dovey Zachary, Zaytoun Osama, Buscarini Maurizio
Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1425 Madison Ave, New York, USA.
Department of Urology, Hamah National Hospital, Hamah, Syria.
J Robot Surg. 2025 Jan 8;19(1):48. doi: 10.1007/s11701-024-02208-x.
Robotic-assisted surgery offers several advantages over traditional methods, such as reduced blood loss and fewer complications. Establishing pneumoperitoneum is a critical step, with two primary techniques: the Veress needle (closed) and the Hasson (open) technique. Despite extensive studies in laparoscopic surgery, limited data exist regarding their use in robotic surgery. This study compares complication rates and predictors between Palmer, umbilical Veress needle, and open Hasson techniques in robotic surgery. In this retrospective cohort study of 9482 patients undergoing robotic surgery, we compared palmer, umbilical Veress needle, and Open Hasson techniques using propensity score matching. Primary outcomes were complication rates classified by the Clavien-Dindo system. We used logistic regression to analyze predictors of complications, such as needle attempts and adhesions. One thousand sixteen patients were matched between Palmer and umbilical groups and 310 between Veress needle and open groups. Umbilical insertion was associated with more complications than Palmer (OR 2.14, p = 0.033). Patients requiring more than four needle attempts had higher complication rates (OR 15.43, p = 0.002). Severe adhesions significantly increased complications. After adjustment, the choice of entry method was not independently associated with complications. Surgical entry complications in robotic-assisted surgery are more influenced by needle attempts and adhesions than by the choice of entry technique. Tailoring surgical plans based on patient characteristics and minimizing needle attempts can improve outcomes, underscoring the importance of individualized approaches over standardized methods.
与传统方法相比，机器人辅助手术具有多项优势，如减少失血和降低并发症发生率。建立气腹是关键步骤，主要有两种技术：Veress针（闭合）技术和Hasson（开放）技术。尽管在腹腔镜手术方面已有广泛研究，但关于它们在机器人手术中的应用数据有限。本研究比较了机器人手术中Palmer法、脐部Veress针穿刺法和开放Hasson技术的并发症发生率及预测因素。在这项对9482例行机器人手术患者的回顾性队列研究中，我们使用倾向评分匹配法比较了Palmer法、脐部Veress针穿刺法和开放Hasson技术。主要结局指标是根据Clavien-Dindo系统分类的并发症发生率。我们使用逻辑回归分析并发症的预测因素，如穿刺尝试次数和粘连情况。在Palmer组和脐部组之间匹配了1016例患者，在Veress针穿刺组和开放组之间匹配了310例患者。脐部穿刺与比Palmer法更多的并发症相关（比值比2.14，p = 0.033）。需要超过4次穿刺尝试的患者并发症发生率更高（比值比15.43，p = 0.002）。严重粘连显著增加并发症。调整后，入路方法的选择与并发症无独立相关性。机器人辅助手术中的手术入路并发症受穿刺尝试次数和粘连的影响大于入路技术的选择。根据患者特征制定手术计划并尽量减少穿刺尝试次数可改善结局，强调了个体化方法优于标准化方法的重要性。
