背景:1989年腹腔镜的引入彻底改变了外科实践,减少术后并发症,和增强成果。尽管有好处,腹腔镜工具的局限性导致继续使用开放手术。机器人辅助手术的出现解决了这些限制,但其采用趋势和对开腹和腹腔镜手术的潜在影响需要分析.
方法:回顾性分析使用2012年至2021年的美国外科医生学会国家外科质量改善计划(ACS-NSQIP)数据库。该研究包括各种腹部手术,采用向量自回归(VAR)模型分析手术技术之间的动态关系。这些模型预测了未来的趋势,腹腔镜,和机器人手术,直到2025年第二季度。
结果:分析包括360,171名不同手术的患者。在泌尿科,机器人手术主导前列腺切除术(2021年为83.1%)和肾切除术(2021年为55.1%),而开放入路仍然是膀胱切除术的主要手术技术(2021年为72.5%)。在普通外科,机器人结肠切除术预计将超过腹腔镜检查,到2024年成为主要方法(2025年为45.7%)。前列腺切除术也显示了向机器人手术的转变,预计到2025年将超过腹腔镜和开放手术(32.3%)。胰腺切除术见证了机器人手术的稳步增长,2021年超过腹腔镜检查,预测显示进一步增加。虽然肝切除术仍以开放为主(2025年为70.0%),食管切除术看到机器人手术的兴起,预计到2025年将成为主要方法(52.3%)。
结论:这项研究表明,向机器人辅助手术转变,准备主导各种微创手术。预测表明,在结肠切除术中,机器人手术可能会超过腹腔镜和开放手术,前列腺切除术,胰腺切除术,到2025年食管切除术。这一预期的变化强调了对外科培训计划进行主动调整的必要性,以适应不断发展的外科实践。这些发现对未来的医疗保健实践具有重要意义,需要在传统的腹腔镜检查和机器人辅助手术的新兴作用之间取得平衡。
BACKGROUND: The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. Robotic-assisted surgery emerged to address these limitations, but its adoption trends and potential impact on open and laparoscopic surgery require analysis.
METHODS: A retrospective analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2012 to 2021. The study encompassed various abdominal procedures, employing Vector Autoregressive (VAR) models to analyze the dynamic relationships between surgical techniques. The models predicted future trends in open, laparoscopic, and robotic surgery until Q2 of 2025.
RESULTS: The analysis included 360,171 patients across diverse procedures. In urology, robotic surgery dominated prostatectomies (83.1% in 2021) and nephrectomies (55.1% in 2021), while the open approach remained the predominant surgical technique for cystectomies (72.5% in 2021). In general surgery, robotic colectomies were forecasted to surpass laparoscopy, becoming the primary approach by 2024 (45.7% in 2025). Proctectomies also showed a shift towards robotic surgery, predicted to surpass laparoscopy and open surgery by 2025 (32.3%). Pancreatectomies witnessed a steady growth in robotic surgery, surpassing laparoscopy in 2021, with forecasts indicating further increase. While hepatectomies remained predominantly open (70.0% in 2025), esophagectomies saw a rise in robotic surgery, predicted to become the primary approach by 2025 (52.3%).
CONCLUSIONS: The study suggests a transformative shift towards robotic-assisted surgery, poised to dominate various minimally invasive procedures. The forecasts indicate that robotic surgery may surpass laparoscopy and open surgery in colectomies, proctectomies, pancreatectomies, and esophagectomies by 2025. This anticipated change emphasizes the need for proactive adjustments in surgical training programs to align with evolving surgical practices. The findings have substantial implications for future healthcare practices, necessitating a balance between traditional laparoscopy and the burgeoning role of robotic-assisted surgery.