通过基于视频的评估分析手术技术对腹腔镜Roux-en-Y胃旁路手术术中不良事件的影响。
Analyzing the impact of surgical technique on intraoperative adverse events in laparoscopic Roux-en-Y gastric bypass surgery by video-based assessment.
作者信息
Lavanchy Joël L, Alapatt Deepak, Sestini Luca, Kraljević Marko, Nett Philipp C, Mutter Didier, Müller-Stich Beat P, Padoy Nicolas
机构信息
University Digestive Health Care Center - Clarunis, PO box, 4002, Basel, Switzerland.
Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
出版信息
Surg Endosc. 2025 Mar;39(3):2026-2036. doi: 10.1007/s00464-025-11557-z. Epub 2025 Jan 31.
BACKGROUND
Despite high-level evidence that variations of surgical technique in laparoscopic Roux-en-Y gastric bypass (LRYGB) are correlated with postoperative outcomes and might be linked to intraoperative adverse events (iAEs), there are a paucity of studies analyzing iAEs in depth. The impact of surgical technique on the temporal occurrence of iAEs regarding phases and steps of LRYGB has not been studied so far. The objective of this study was to analyze the impact of variance in surgical technique on temporal occurrence, frequency, and type of iAEs in a multicentric dataset of LRYGB videos.
METHODS
MultiBypass140, a video dataset containing 70 LRYGB surgeries each from Strasbourg University Hospital (StrasBypass70) and Bern University Hospital (BernBypass70) was annotated with surgical phases, iAE type, and grade. The cumulative severity of iAEs per procedure was measured using the SEVERE score and correlated with procedure duration.
RESULTS
Surgical technique significantly differed between StrasBypass70 and BernBypass70 (omentum division: 94% vs. 36%, p < 0.01; closure of mesenteric defects: 100% vs. 21%, p < 0.01). In MultiBypass140, a total of 797 iAEs were analyzed. The most iAE-prone phases were gastric pouch creation, gastrojejunal, and jejunojejunal anastomosis creation containing 77% (616/797) of all iAEs. StrasBypass70 showed significantly more iAEs in the omentum division (23 vs. 5, p < 0.01), Petersen space closure (13 vs. 1, p < 0.01), and mesenteric defect closure phases (34 vs. 1, p < 0.01) compared to BernBypass70. In both centers, SEVERE score was correlated with procedure duration. In BernBypass70, insufficient closure of anastomosis was significantly more frequent in patients with postoperative complications (0.2 ± 0.6 vs. 0.0 ± 0.1, p < 0.01).
CONCLUSION
Variations of the LRYGB technique between centers influence the temporal occurrence and frequency of iAEs. The frequency and severity of iAEs are correlated with procedure duration.
背景
尽管有高级别证据表明腹腔镜Roux-en-Y胃旁路术（LRYGB）手术技术的差异与术后结果相关，且可能与术中不良事件（iAEs）有关，但深入分析iAEs的研究却很少。到目前为止，尚未研究手术技术对LRYGB各阶段和步骤中iAEs发生时间的影响。本研究的目的是在LRYGB视频的多中心数据集中分析手术技术差异对iAEs发生时间、频率和类型的影响。
方法
MultiBypass140是一个视频数据集，包含来自斯特拉斯堡大学医院（StrasBypass70）和伯尔尼大学医院（BernBypass70）的各70例LRYGB手术，标注了手术阶段、iAE类型和等级。使用SEVERE评分测量每个手术中iAEs的累积严重程度，并与手术持续时间相关联。
结果
StrasBypass70和BernBypass70之间的手术技术存在显著差异（网膜分离：94%对36%，p＜0.01；肠系膜缺损闭合：100%对21%，p＜0.01）。在MultiBypass140中，共分析了797例iAEs。最容易发生iAEs的阶段是胃小囊创建、胃空肠和空肠空肠吻合创建，占所有iAEs的77%（616/797）。与BernBypass70相比，StrasBypass70在网膜分离阶段（23例对5例，p＜0.01）、彼得森间隙闭合阶段（13例对1例，p＜0.01）和肠系膜缺损闭合阶段（34例对1例，p＜0.01）显示出明显更多的iAEs。在两个中心，SEVERE评分均与手术持续时间相关。在BernBypass70中，术后并发症患者吻合口闭合不充分的情况明显更频繁（0.2±0.6对0.0±0.1，p＜0.01）。
结论
各中心之间LRYGB技术的差异会影响iAEs的发生时间和频率。iAEs的频率和严重程度与手术持续时间相关。
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