最近,复杂乙状结肠憩室炎的微创治疗正成为标准手术的有效替代方法。机器人方法可能有助于在复杂的憩室炎的艰巨盆腔解剖中进行更精确的解剖。这项研究的目的是调查有效性,机器人辅助腹腔镜手术切除的潜在益处和短期结果,与复杂憩室炎的完全腹腔镜切除术相比。
在2009年1月至2017年12月期间,156名具有复杂憩室疾病病史的连续患者被转诊至我们的综合科,微创和机器人手术。所有患者均接受了由同一结直肠外科医生进行的选择性结肠切除术,并遵循围手术期ERAS计划。人口统计学和临床特征,手术数据,术后数据,30天发病率和死亡率,评估VAS对外科医生的依从性。
一百五十六个连续患者接受了选择性结肠切除术:92例全腹腔镜(FL)结直肠切除术和64例机器人混合方法(RHA)手术。RHA组无转化率,FL组为6.5%,因为肠道扩张导致视力不好,炎性假瘤和腹膜粘连。没有观察到30天的死亡率。FL组的平均手术时间为167.5±54.4分钟(80-420),RHA组为172.5±55.64分钟(110-325)(p0.079),FL技术的平均术中失血量为144.6±40.6ml(40-200),RHA技术的平均术中失血量为138.4±28.3ml(20-185)(p0.295).FL的平均住院时间为5±4.1天(范围3-45)和RHA的5±2.7天(范围3-20)(p0.974)。FL组术后总发病率为21.6%,RHA组为12.3%(p0.067)。术后主要发病率(Clavien-Dindo3和4)分别为13%和4.6%,分别(p0.091)。外科医生依从性的VAS显示机器人手臂的性能更好(第0.059页)。
这项初步研究强调了机器人辅助腹腔镜在复杂憩室疾病的结直肠切除术中在手术疗效方面的潜在益处。术后发病率和更好的外科医生依从性。
Recently, minimally invasive treatment of complicated sigmoid diverticulitis is becoming a valid alternative to standard procedures. Robotic approach may be useful to allow more precise dissection in arduous pelvic dissection as in complicated diverticulitis. The aim of this
study is to investigate effectiveness, potential benefits and short-term outcomes of robotic-assisted laparoscopic surgical resection, compared with fully laparoscopic resection in complicated diverticulitis.
Between January 2009 and December 2017, 156 consecutive patients with history of complicated diverticular disease were referred to our Department of General, Mininvasive and Robotic Surgery. All patients underwent elective colonic resections performed by the same colorectal surgeon and followed a perioperative ERAS program. Demographic and clinical features, surgical data, postoperative data, 30-day morbidity and mortality, VAS for surgeon\'s compliance were evaluated.
One hundred and fifty-six consecutive patients underwent elective colonic resection: 92 fully laparoscopic (FL) colorectal resections and 64 procedures with robotic hybrid approach (RHA). Conversion rate was none in the RHA group versus 6.5% in the FL group, because of poor vision due to bowel distension, inflammatory pseudotumor and peritoneal adhesions. No 30-day mortality was observed. Mean operative time was 167.5 ± 54.4 min (80-420) in the FL group and 172.5 ± 55.64 min (110-325) in the RHA group (p 0.079), mean intraoperative blood loss was 144.6 ± 40.6 ml (40-200) with the FL technique and 138.4 ± 28.3 ml (20-185) with the RHA (p 0.295). Mean hospital stay for FL was 5 ± 4.1 days (range 3-45) and 5 ± 2.7 days (range 3-20) for RHA (p 0.974). Overall postoperative morbidity rate was 21.6% in the FL group and 12.3% in the RHA (p 0.067). Major postoperative morbidity (Clavien-Dindo 3 and 4) represented 13% and 4.6%, respectively (p 0.091). VAS for surgeon\'s compliance revealed a better performance in the robotic arm (p 0.059).
This preliminary
study highlights the potential benefits of robotic-assisted laparoscopy in colorectal resections for complicated diverticular disease in terms of surgical efficacy, postoperative morbidity and better surgeon\'s compliance.