背景:机器人手术在减肥代谢手术中越来越受欢迎。然而,与传统腹腔镜相比,其在术后结局方面的优越性尚未得到明确证实.随着越来越多地采用机器人手术和改进的技术,好处应该变得更加明显。
目的:评估2015年至2021年通过传统腹腔镜与机器人辅助进行减重代谢手术后的再入院率和再手术率。
方法:学术机构。
方法:对代谢和减重手术认证和质量改进计划(MBSAQIP)进行了综述,用于常规腹腔镜与机器人辅助进行的原发性减重手术。在倾向评分匹配的样本中比较术后结果。
结果:符合纳入标准的1,059,348例,921,322(87%)是传统的腹腔镜减肥代谢手术,与机器人辅助病例1:1匹配(138,026)。再手术(比值比[OR]1.07;95%置信区间[CI]1.00-1.15,P=.0463),术后发病率(OR1.07;95%CI1.01-1.12,P=0.0193),再入院(OR1.14;95%CI1.09-1.18,P<0.0001),对于机器人辅助病例,术后30天的急诊就诊(OR1.06;95%CI1.03-1.09,P=.0003)明显更多。与传统腹腔镜病例相比,机器人辅助病例在术后30天的死亡率相似,住院时间>3天。在2020年至2021年的病例中观察到类似的结果,除了再次手术和急诊科就诊,这表明两组之间没有差异,住院时间>3天,在机器人辅助的情况下更大。
结论:我们的结果显示,与传统腹腔镜手术相比,机器人辅助减重代谢手术术后30天的再入院率和再手术率更高,发病率更高。仅分析2020年至2021年之间进行的病例,机器人手术也没有显示出优于传统腹腔镜的优势。
BACKGROUND: Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident.
OBJECTIVE: Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021.
METHODS: Academic institution.
METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample.
RESULTS: Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15, P = .0463), postoperative morbidity (OR 1.07; 95% CI 1.01-1.12, P = .0193), readmission (OR 1.14; 95% CI 1.09-1.18, P < .0001), and emergency department visits (OR 1.06; 95% CI 1.03-1.09, P = .0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases.
CONCLUSIONS: Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy.