在采用机器人辅助手术的情况下,评估垂直袖套胃切除术后出血风险和体积与预后的关系。

IF 2.4 2区 医学 Q2 SURGERY
Katharine P Playter, Hayley Reddington, Zachary C Ballinger, Donald R Czerniach, Gil S Freitas, John J Kelly, Nicole B Cherng, Richard A Perugini
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引用次数: 0

摘要

背景:机器人辅助手术(RAS)有望维持减肥结果,同时相对于传统腹腔镜手术提供更短的采用学习曲线。然而,相对于腹腔镜方法的低RAS手术体积限制了我们对其影响的理解,并且从腹腔镜到RAS的过渡需要体积-结果关系,目前尚未完全表征。方法:这是一项通过MBSAQIP认证的减肥手术项目的回顾性队列研究。观察2020 ~ 2023年垂直袖式胃切除术(VSG)术后出血的发生率。这一阶段分为早期采用期(占31%)和晚期采用期(占82%)。结果:在研究期间,共有1250例患者接受了VSG。腹腔镜VSG (L-VSG)组和机器人辅助VSG (RA-VSG)组在年龄、性别和术后出血危险因素方面相似。结论:随着RA-VSG成为单一项目中更常用的方法,L-VSG出血的风险显著增加。这表明向机器人方法过渡会带来意想不到的风险。特别是,在以RA-VSG为主的实践中,进行L-VSG时并发症的风险增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of hemorrhage risk and the volume-outcome relationship following vertical sleeve gastrectomy amidst robotic-assisted surgery adoption.

Background: Robotic-assisted surgery (RAS) holds promise for maintaining bariatric outcomes, while offering a shorter adoption learning curve relative to conventional laparoscopy. However, low RAS procedure volume relative to a laparoscopic approach has limited our understanding of its impact, and the transition from laparoscopic to RAS entails a volume-outcome relationship that is not fully characterized.

Methods: This is a retrospective cohort study in a MBSAQIP accredited, bariatric surgery program. The incidence of hemorrhage following vertical sleeve gastrectomy (VSG) was observed from 2020 to 2023. This period was divided into an early adoption period (RAS 31% of cases) and a late adoption period (RAS 82% of cases).

Results: A total of 1250 patients underwent VSG over the study period. Laparoscopic VSG (L-VSG) and robotic-assisted VSG (RA-VSG) groups were similar in age, sex, and risk factors for postoperative bleeding. They differed in race (P < 0.0001) and ASA category (P = 0.007). The overall postoperative hemorrhage rate was 1.04% (n = 13). Hyperlipidemia was predictive of hemorrhage on univariate analysis (P = 0.045). The relative risk of hemorrhage in the robotic group dropped from 4.38 (CI 0.577-3.24) during the early adoption period to 0.28 (CI 0.083-0.96, P = 0.063) during the late adoption period. This shift with respect to hemorrhage risk was not associated with a significant reduction of hemorrhage in the RA-VSG approach (1.5% vs. 0.98%; P = 0.636), but with an increase in L-VSG risk (0.35% vs. 3.5%, P = 0.0245).

Conclusion: As RA-VSG became the more frequently utilized approach within a single program, the risk of hemorrhage with L-VSG significantly increased. This suggests an unanticipated risk associated with a transition to the robotic approach. Specifically, the risk of complication increased when performing L-VSG in a practice dominated by RA-VSG.

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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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