背景：腹腔镜手术广泛用于腹部急诊手术（AES），并且将这种方法扩展到最近的机器人手术（RS）的可能性引起了极大的兴趣。与腹腔镜检查相比，机器人技术的缓慢扩散主要是由于高成本和较长的RS手术时间可能是不利的。尤其是在AES中。本研究旨在报告我们在AES中使用RS评估其安全性和可行性的经验，特别关注术中和术后并发症，转化率，和外科学习曲线。通过广泛的文献回顾，我们的数据也与其他经验进行了比较。
方法：我们回顾性分析了过去10年的单外科医生系列。从2014年1月到2023年12月，36例患者接受了紧急或急诊RS。使用的机器人设备为达芬奇Si（15例）和Xi（21例）。
结果：我们的分析包括834个机器人程序中的36个（4.3％）：20个（56.56％）女性。平均年龄为63岁，30％的患者≥70岁。2（5.55％）手术在夜间进行。此系列中没有报告要打开的转换。根据Clavien-Dindo分类，收集2例（5.5％）主要并发症。术中和30天死亡率为0%。
结论：我们的研究表明，当在训练有素的机器人中心对部分血流动力学稳定的患者进行手术时，RS可能是一种有用且可靠的方法，也可以用于AES和术中腹腔镜并发症。该技术可以在完全机器人或混合方法中增加紧急设置中的微创使用和转换率。
BACKGROUND: Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature
review.
METHODS: We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases).
RESULTS: 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%.
CONCLUSIONS: Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach.
