Graham J Spurzem, Ryan C Broderick, Emily K Kunkel, Hannah M Hollandsworth, Bryan J Sandler, Garth R Jacobsen, Santiago Horgan
{"title":"与腹腔镜相比，机器人袖带胃切除术的并发症发生率更高：机器人与腹腔镜初级减肥手术的8年分析。","authors":"Graham J Spurzem, Ryan C Broderick, Emily K Kunkel, Hannah M Hollandsworth, Bryan J Sandler, Garth R Jacobsen, Santiago Horgan","doi":"10.1016/j.soard.2024.11.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.</p><p><strong>Objective: </strong>Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.</p><p><strong>Setting: </strong>United States.</p><p><strong>Methods: </strong>A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables.</p><p><strong>Results: </strong>A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group.</p><p><strong>Conclusion: </strong>Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Robotic sleeve gastrectomy has higher complication rates compared to laparoscopic: 8-year analysis of robotic versus laparoscopic primary bariatric surgery.\",\"authors\":\"Graham J Spurzem, Ryan C Broderick, Emily K Kunkel, Hannah M Hollandsworth, Bryan J Sandler, Garth R Jacobsen, Santiago Horgan\",\"doi\":\"10.1016/j.soard.2024.11.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.</p><p><strong>Objective: </strong>Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.</p><p><strong>Setting: </strong>United States.</p><p><strong>Methods: </strong>A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables.</p><p><strong>Results: </strong>A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group.</p><p><strong>Conclusion: </strong>Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.</p>\",\"PeriodicalId\":94216,\"journal\":{\"name\":\"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.soard.2024.11.014\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.soard.2024.11.014","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：机器人辅助减肥手术正在迅速发展。减少并发症的最佳方法尚不清楚。目的：利用代谢和减肥手术认证和质量改进计划（MBSAQIP）数据库评估机器人的使用情况，并比较腹腔镜和机器人初级袖式胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）的30天疗效。背景：美国。方法：回顾性分析MBSAQIP数据库，确定2015年至2022年原发性SG和RYGB病例。排除修正/转换，转换为其他入路的病例，以及除食管胃十二指肠镜检查外的联合病例。结果采用1:1倾向评分匹配的逻辑回归进行比较，以调整患者人口统计学/合并症和手术变量的差异。结果：共823902例(591118例；232,784 RYGB)。从2015年到2022年，机器人完成的SG和RYGB的比例分别从6.7%和6.9%增加到29.5%和31.8%。与腹腔镜相比，机器人SG的总发病率（优势比1.14 [1.07-1.21],P < .001）、漏出（优势比1.24 [1.05-1.46],P = .03）和出血率（优势比1.34 [1.13-1.58],P < .001）显著高于腹腔镜。机器人RYGB的总体发病率显著降低。- 75 .70美元。[81], P < 0.001)和出血（P < 0.001）。80 .68点-。[94], P < 0.01)，泄漏率相似(。[.71-1.07], p = .18)。在2020-2022年的病例中，联合机器人SG和RYGB的结果与腹腔镜相似，除了机器人组的器官/空间感染、再入院率和感染性休克率更高。结论：与腹腔镜手术相比，机器人SG的并发症发生率更高，而机器人RYGB对出血并发症有保护作用。机器人手术的短期效果已经越来越接近腹腔镜手术，但仍然较差。需要进一步的研究来阐明导致这些发现的因素。
Robotic sleeve gastrectomy has higher complication rates compared to laparoscopic: 8-year analysis of robotic versus laparoscopic primary bariatric surgery.
Background: Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.
Objective: Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
Setting: United States.
Methods: A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables.
Results: A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group.
Conclusion: Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.
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