与腹腔镜手术相比,机器人手术并不能消除减肥手术的第一助手。

IF 2.4 2区 医学 Q2 SURGERY
Luis Pina, Conor M Eufemio, James Dove, G Craig Wood, Mark Mahan, Alexandra Falvo, Ryan Horsley, Benefsha Mohammad, Vladan Obradovic, Anthony T Petrick, David M Parker
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引用次数: 0

摘要

简介:腹腔镜袖胃切除术(LSG)和腹腔镜Roux-en-Y胃旁路术(LRYGB)是美国最常见的减肥代谢手术(BMS)。机器人辅助BMS病例的数量仍然很低,主要是由于与该技术相关的成本增加和手术时间延长。我们的主要目的是评估机器人平台是否减少了对外科第一助理(FA)的需求。我们的第二个目标是比较熟练手术助理的使用情况。方法:我们对2015年至2019年MBSAQIP参与者使用档案队列进行了回顾性分析,以确定与非医师外科第一助理相比,主治医生参与机器人辅助、腹腔镜RYGB和SG手术的发生率。涉及医疗实习生(住院医师和研究员)的病例被排除在分析之外。对于每个减肥手术,我们建立了两个不同的组,并采用倾向评分匹配来确保患者的可比性。“良好匹配”定义为标准化平均差(SMD)小于0.10。结果:共113,682例患者接受了LRYGB, 12,480例患者接受了机器人RYGB (RRYGB)。在1:1的比赛后,LRYGB病例中有25.9%涉及在场fa, 55.6%涉及中级fa, 18.5%没有助理。相比之下,RRYGB病例中有13.7%的病例使用了主治水平的FAs, 68.4%的病例使用了中级水平的FAs, 17.9%的病例没有助手(P结论:机器人平台未能显示Roux-en-Y胃旁路(RYGB)手术中对助手的需求减少,但确实导致了袖胃切除术(SG)中所需助手数量的减少。对于大多数机器人和腹腔镜减肥代谢病例,中级辅助是必要的。在机器人手术过程中,机器人平台对主治人员辅助的需求减少了大约12%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Robotic approach does not eliminate first assistant in bariatric surgery compared to laparoscopy.

Introduction: Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) constitute the most commonly performed bariatric metabolic surgery (BMS) procedures in the USA. The number of robotic-assisted BMS cases remains low, primarily due to the increased cost and extended operative time associated with this technology. Our primary objective is to assess whether robotic platform reduces the need for a surgical first assistant (FA). Our secondary objective is to compare the utilization of skilled surgical assistants.

Methods: We conducted a retrospective analysis of the MBSAQIP Participant Use File cohort spanning from 2015 to 2019 to determine the prevalence of Attending Surgeon involvement in robotic-assisted, laparoscopic RYGB, and SG procedures, in comparison to non-physician surgical First Assistants. Cases involving medical trainees (residents and fellows) were excluded from the analysis. For each bariatric procedure, we established two distinct groups and employed propensity score matching to ensure patient comparability. A "good match" was defined as a standardized mean difference (SMD) of less than 0.10. All statistical analyses were two-sided, with a significance level set at P < 0.05.

Results: A total of 113,682 patients underwent LRYGB, with 12,480 undergoing robotic RYGB (RRYGB). After a 1:1 match, attending-level FAs were involved in 25.9% of LRYGB cases, mid-level FAs in 55.6%, and no assistants in 18.5%. In contrast, RRYGB cases utilized attending-level FAs in 13.7% of cases, mid-level FAs in 68.4%, and had no assistants in 17.9% of cases (P < 0.0001). In LSG, attending-level FAs were present in 28.1% of cases, mid-level FAs in 51.6%, and no assistants in 20.3%. In comparison, robotic SG (RSG) cases had attending-level FAs in 16.1%, mid-level FAs in 55.6%, and no assistants in 28.3% of cases (P < 0.0001).

Conclusion: The robotic platform failed to show a reduction in the need for an assistant in Roux-en-Y Gastric Bypass (RYGB) procedures but did lead to a decrease in the number of assistants required in sleeve gastrectomy (SG). Mid-level assistance was necessary for the majority of robotic and laparoscopic bariatric metabolic cases. The robotic platform was associated with an approximate 12% reduction in the requirement for attending-level assistance in robotic procedures.

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来源期刊
CiteScore
6.10
自引率
12.90%
发文量
890
审稿时长
6 months
期刊介绍: Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research. Topics covered in the journal include: -Surgical aspects of: Interventional endoscopy, Ultrasound, Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, -Gastroenterologic surgery -Thoracic surgery -Traumatic surgery -Orthopedic surgery -Pediatric surgery
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