Abstract：
The robotic approach improves the feasibility of minimally invasive colectomy even where there may be an anatomic challenge with laparoscopy. Whether a failure in completing colectomy with this newer technology is associated with worse consequences needs to be considered when evaluating the relative benefit of robotic colectomy. The aim of this study is to evaluate rates of conversion to open surgery after robotic and laparoscopic colectomy and whether outcomes after conversion vary after the two techniques since this has not been well studied. From the American College of Surgeons (ACS) - National Surgical Quality Improvement Program (NSQIP) (2015-2016), patients who underwent elective minimally invasive colectomy were identified. Converted robotic were compared to laparoscopic procedures for patient demographics, co-morbidities; primary procedure and diagnosis, prolonged operation and postoperative complications. Of 36,046 colectomy procedures, 30,808 (85.5%) were laparoscopic, while 5238 (14.5%) were robotic-assisted. There were 3271 (9.1%) conversions to open surgery (laparoscopic: 2959 [9.6%]; robotic: 312 [6%]). Thirty-day postoperative surgical site infection, anastomotic leak, ileus, sepsis, bleeding requiring transfusion, urinary tract infection, reoperation; pulmonary, renal, cardiac/cerebrovascular complications; readmission, hospital stay, and mortality, were similar between the two groups. However, deep vein thrombosis/pulmonary embolism was higher after robotic conversion (4.5% vs. 2.2%, p = 0.01). Conversion was lower after robotic when compared to laparoscopic colectomy. Converted patients had similar outcomes except for vein thromboembolism which was higher after robotic surgery. Robotic technology seems to improve the feasibility of minimally invasive surgery without negatively affecting safety and efficacy even when conversion is required.
摘要：
即使在腹腔镜检查可能存在解剖挑战的情况下，机器人方法也提高了微创结肠切除术的可行性。在评估机器人结肠切除术的相对益处时，需要考虑使用这种新技术完成结肠切除术的失败是否与更糟糕的后果有关。这项研究的目的是评估机器人和腹腔镜结肠切除术后转换为开腹手术的比率，以及两种技术后转换后的结果是否有所不同，因为这尚未得到很好的研究。来自美国外科医生学院（ACS）-国家外科质量改进计划（NSQIP）（2015-2016），我们确定了接受择期微创结肠切除术的患者.将转换后的机器人与患者人口统计学的腹腔镜手术进行了比较，合并症；主要程序和诊断，延长手术时间和术后并发症。在36,046例结肠切除术中，30,808（85.5％）进行了腹腔镜检查，而5238（14.5%）是机器人辅助的。有3271例（9.1％）转换为开放手术（腹腔镜：2959[9.6％]；机器人：312[6％]）。术后30天手术部位感染,吻合口漏,肠梗阻,脓毒症,需要输血的出血,尿路感染,再次手术;肺性,肾,心/脑血管并发症;再入院,住院,和死亡率，两组之间相似。然而,机器人转换后深静脉血栓/肺栓塞发生率更高(4.5%vs.2.2%,p=0.01)。与腹腔镜结肠切除术相比，机器人术后的转化率较低。转换后的患者具有相似的结果，除了机器人手术后静脉血栓栓塞较高。机器人技术似乎提高了微创手术的可行性，即使需要转换也不会对安全性和有效性产生负面影响。
