Nicolas Zucchini, Eleonora Locci, Enrico Moroni, Giovanni Fantola
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Metabolic and Obesity Surgery Unit, ARNAS G. Brotzu, Cagliari, Italy.
J Robot Surg. 2025 May 24;19(1):233. doi: 10.1007/s11701-025-02396-0.
Robotic bariatric surgery (RBS) is increasingly adopted worldwide. This study aims to evaluate the implementation and evolution of RBS at a high volume center over five years, focusing on operative time (OT), operating room (OR) efficiency, and cost outcomes. A prospective analysis was conducted on patients undergoing elective RBS between July 2021 and March 2025 at ARNAS G. Brotzu, Cagliari. Metrics included OT, OR session time, and surgical volume. Variables analyzed included OT, OR session time, and surgical volume. Efficiency metrics such as overall OR efficiency, defined as OR session time/OT (Eff1), and robotic console utilization, defined as OR session time/console time (Eff2) were derived. Cost analysis incorporated OR activation time, surgeon and material costs. Statistical analyses included t-tests, Pearson's correlation, and linear regression. 100 robotic-assisted procedures were recorded. Robotic adoption increased from 4.06% in 2021 to 38.98% in 2025. A learning curve (LC) was identified, with a significant OT reduction after the first 34 Roux-en-Y gastric bypass cases (p = 0.001). Full robotic manual anastomosis showed a notable cost decrease in later cases (p < 0.0001). Increased surgical volume correlated with both reduced OT (r = - 0.58) and improved Eff1 (r = - 0.49, p = 0.005). However, Eff2 changes were not statistically significant (r = - 0.31, p = 0.09), underscoring the need for team-wide coordination. RBS in high-volume centers enhance OR efficiency and cost-effectiveness over time. The LC, surgical volume, and institutional workflows were key factors in optimizing efficiency, highlighting the importance of a collective LC for the entire surgical team.
机器人减肥手术（RBS）在全球范围内的应用越来越广泛。本研究旨在评估一家大型中心在五年内RBS的实施情况和发展，重点关注手术时间（OT）、手术室（OR）效率和成本结果。对2021年7月至2025年3月在卡利亚里的ARNAS G. Brotzu接受择期RBS的患者进行了前瞻性分析。指标包括OT、手术时间和手术量。分析的变量包括OT、手术时间和手术量。得出了效率指标，如总体手术室效率，定义为手术时间/OT（Eff1），以及机器人控制台利用率，定义为手术时间/控制台时间（Eff2）。成本分析纳入了手术室启动时间、外科医生和材料成本。统计分析包括t检验、Pearson相关性分析和线性回归。记录了100例机器人辅助手术。机器人手术的采用率从2021年的4.06%增加到2025年的38.98%。确定了一条学习曲线（LC），在前34例Roux-en-Y胃旁路手术后OT显著缩短（p = 0.001）。完全机器人手动吻合术在后期病例中成本显著降低（p < 0.0001）。手术量增加与OT缩短（r = - 0.58）和Eff1改善（r = - 0.49，p = 0.005）相关。然而，Eff2的变化无统计学意义（r = - 0.31，p = 0.09），这突出了团队协作的必要性。随着时间的推移，大型中心的RBS提高了手术室效率和成本效益。学习曲线、手术量和机构工作流程是优化效率的关键因素，凸显了整个手术团队共同学习曲线的重要性。
