腹腔镜与机器人胃切除术在完全性胃逆位患者中的应用:一项系统综述。

IF 1.3 Q3 SURGERY
Anmol Multani, Simran Parmar, Elijah Dixon
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引用次数: 2

摘要

背景:完全性倒位(SIT)是一种罕见的涉及器官镜像移位的遗传异常。由于反向解剖和术中混淆,这种转位可能使手术治疗变得困难。本系统综述的目的是比较机器人和腹腔镜胃切除术治疗SIT患者的围手术期结果和安全性。方法:我们纳入了年龄≥21岁、接受腹腔镜或机器人胃切除术的SIT患者的全文病例报告、简要回顾和独立病例研究。我们排除了除腹腔镜和机器人胃切除术以外的其他手术的病例研究,即开放式胃切除术、胃束带和胃旁路。选择英语作为语言,选取近10年发表的文章,时间范围为2011年1月至2021年8月。我们关注术中和术后结果,包括出血量、血管异常、手术时间、死亡率、手术并发症、住院时间和随访时间。在线数据库包括Clinical Key、Embase、ScienceDirect、Ovid和Google Scholar。最后一次搜索是在2021年8月15日。对所有符合条件的文章,采用JBI关键评价表进行偏倚风险评估(表1)。对连续资料进行t检验,p值为0.05。结果:从我们的搜索中,我们保留了29例报告,其中报告了30例的信息。对各研究报告的结果进行总结(表2)。21例采用腹腔镜手术,9例采用机器人辅助手术。30例中有24例涉及手术时间,平均手术时间为205.67 min。30例患者中有16例出现失血量,平均失血量51.9 mL。30例中有26例提供了住院信息,平均住院时间为8.5天。手术时间、住院时间和患者年龄没有统计学上的显著差异。而机器人辅助胃切除术术中出血量较腹腔镜胃切除术低,p值为0.0293。无围手术期死亡报告。在腹腔镜手术中仅报告了3例术后并发症。三个病例中只有一个认为并发症是由于异常引起的,而另外两个报告的并发症是由于手术错误引起的。结论:在谨慎操作的情况下,腹腔镜和机器人胃切除术可安全用于SIT患者。一些预防措施包括使用术前成像彻底评估解剖畸变,调整手术设置,并有经验丰富的外科医生。机器人方法可能比腹腔镜手术有一些优势,可以提高SIT患者的手术安全性,需要在未来的研究中进一步探索。机器人入路的优势可能包括手术安全性的提高,手术视野的更好可视化,促进手术器械的稳定性,以及在对SIT患者进行手术时手术方向和定位的便利性。这一领域值得进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review.

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review.

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review.

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review.

Background: Situs inversus totalis (SIT) is a rare genetic anomaly involving the mirror-image transposition of organs. This transposition can potentially make surgical treatments difficult because of the reversed anatomy and intraoperative confusion. The aim of this systematic review is to compare the perioperative outcomes and safety of robotic and laparoscopic gastrectomy in patients with SIT.

Methods: We included full-text case reports with brief reviews and standalone case studies on SIT patients age ≥21, undergoing laparoscopic or robotic gastrectomy. We excluded case studies focusing on procedures other than laparoscopic and robotic gastrectomy, namely, open gastrectomy, gastric banding, and gastric bypass. English was selected as the language and articles published in the last 10 years were selected with a date range from Jan, 2011, to Aug, 2021. We focused on intraoperative and postoperative outcomes including blood loss, vascular aberrancy, operation duration, mortality, operative complications, duration of hospitalization, and follow-up interval. Online databases included Clinical Key, Embase, ScienceDirect, Ovid, and Google Scholar. The last search was conducted on Aug 15, 2021. For all eligible articles, risk of bias assessment was carried out using JBI critical appraisal checklist (Table 1). Continuous data were analyzed using t-test with p value of 0.05.

Results: From our search, we retained 29 case reports which reported information from 30 cases. The results reported in each study were summarized (Table 2). The laparoscopic procedure was used in 21 cases and robot-assisted surgery was used in 9 cases. Operative time was mentioned in 24 out of the 30 cases and the average operative time was 205.67 min. Blood loss was reported in 16 out of the 30 cases, with an average blood loss of 51.9 mL. Hospital stay information was provided in 26 out of the 30 cases, with an average length of stay of 8.5 days. A statistically significant difference was not found for the operative time, length of hospitalization, or age of the patient. However, intraoperative blood loss in robot-assisted gastrectomy was lower compared to laparoscopic gastrectomy, with a p value of 0.0293. Perioperative death was not reported in any of the cases. Only three cases of postoperative complications were reported in laparoscopic surgery. Only one of the three cases suggested that the complication was due to an anomaly, whereas the other two of them reported complications due to procedural errors.

Conclusion: Laparoscopic and robotic gastrectomy can be safely used for SIT patients if performed cautiously. Some precautions include thoroughly assessing anatomical aberrations using preoperative imaging, adjusting the operative set up, and having experienced surgeons. The robotic approach may have a few advantages over laparoscopic procedures that may enhance the surgical safety for SIT patients and need to be further explored in future research. Advantages of the robotic approach may include improved surgical safety with better visualization of the surgical field, promoting the stability of surgical instruments and perhaps allowing ease of surgical orientation and positioning when operating on patients with SIT. Further research in this field is merited.

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