Brosnihan Paul J, Moazzez Ashkan, Ozao-Choy Junko J, Yetasook Amy K, Perez Christian
Department of General Surgery, Harbor UCLA Medical Center, Torrance, CA, USA.
Am Surg. 2025 Oct;91(10):1698-1703. doi: 10.1177/00031348251353068. Epub 2025 Jun 19.
IntroductionRobotic inguinal hernia repair (RIHR) has been previously compared to laparoscopic (LIHR) and open (OIHR) approaches and found to be safe and effective. However, recent analysis utilizing large national databases is limited.ObjectiveTo compare the outcomes of RIHR to LIHR and OIHR, including morbidity, mortality and operative time.ParticipantsThe 2022 ACS National Surgical Quality Improvement database was queried to identify all adult patients with a diagnosis of inguinal hernia who underwent an elective RIHR, LIHR or OIHR. Chi-square and Fisher's exact tests were used to analyze the categorical data and ANOVA was utilized to analyze continuous variables.ResultsAmong 27 755 patients, 7306 underwent RIHR. The robotic approach had the highest average BMI (mean RIHR 27.4 vs LIHR 26.7 vs OIHR 26.0 =< .001). RIHR was found to be independently associated with longer operative time in multivariate linear regression when compared to the other platforms (LIHR β + -16.894, 95% CI -18.251: -15.538, = .001 vs OIHR β + -12.056, 95% CI -13.260: -10.852, = .001). In multivariate logistic regression, approach was not independently associated with mortality (LIHR AOR 0.631, = .707 vs OIHR. (AOR 3.29, = .112). However, surgical approach was found to have an independent risk of overall morbidity when compared to OIHR (RIHR AOR 0.702 = .01 vs LIHR AOR 0.702 = .01).ConclusionIn this retrospective study, RIHR is shown to have equivalent morbidity and mortality with longer operative times compared to the other approaches in both initial and recurrent unilateral and bilateral inguinal hernias.
引言
机器人腹股沟疝修补术（RIHR）此前已与腹腔镜腹股沟疝修补术（LIHR）和开放腹股沟疝修补术（OIHR）进行比较，结果显示该手术安全有效。然而，近期利用大型国家数据库进行的分析较为有限。
目的
比较RIHR与LIHR及OIHR的手术结果，包括发病率、死亡率和手术时间。
研究对象
查询2022年美国外科医师学会国家外科质量改进数据库，以确定所有诊断为腹股沟疝并接受择期RIHR、LIHR或OIHR的成年患者。采用卡方检验和Fisher精确检验分析分类数据，采用方差分析（ANOVA）分析连续变量。
结果
在27755例患者中，7306例接受了RIHR。机器人手术方式的平均体重指数最高（RIHR平均为27.4，LIHR为26.7，OIHR为26.0，P<0.001）。在多变量线性回归分析中，与其他手术平台相比，RIHR与更长的手术时间独立相关（与LIHR相比，β=-16.894，95%置信区间为-18.251：-15.538，P=0.001；与OIHR相比，β=-12.056，95%置信区间为-13.260：-10.852，P=0.001）。在多变量逻辑回归分析中，手术方式与死亡率无独立相关性（LIHR的调整后比值比[AOR]为0.631，P=0.707；OIHR的AOR为3.29，P=0.112）。然而，与OIHR相比，手术方式与总体发病率存在独立风险（RIHR的AOR为0.702，P=0.01；LIHR的AOR为0.702，P=0.01）。
结论
在这项回顾性研究中，结果显示，在初次及复发性单侧和双侧腹股沟疝手术中，RIHR与其他手术方式相比，发病率和死亡率相当，但手术时间更长。
