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首页> 外文期刊>Surgical Endoscopy >Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison
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Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison

机译：机器人或三维（3D）腹腔镜检查右侧切除术，具有完整的培素切除切除（CME）和体内吻合术？ 倾向分数匹配研究比较

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Background We describe our preliminary experience in complete mesocolic excision (CME) with central vascular ligation (CVL) and intracorporeal anastomosis for right colon cancer, comparing the robotic and the three-dimensional (3D) laparoscopic approach. Methods We performed a retrospective observational clinical cohort study on patients who underwent radical curative surgical resection of right colon cancer with CME from January 2014 to June 2019. Propensity scores were calculated by bivariate logistic regression, including the following variables: age, BMI, and size of tumor. Results Fifty-five patients underwent CME with CVL: 26 by means of robot-assisted surgery and 29 by means of 3D laparoscopic procedure. There were not statistically significant differences about all the intra- and postoperative outcomes (operative time, length of the specimen, time to bowel canalization, time to soft oral intake, length of hospital stay, postoperative complication, number of retrieved lymph nodes, number of positive lymph nodes and lymph node ratio) between the robotic and the 3D laparoscopic approach. After the matching procedure, 20 patients of the robotic group and 20 patients of the 3D laparoscopic group were selected for the analysis. There were no differences in any of the analyzed variables between the two groups except for longer operative time in the robotic group (p = 0.002). Conclusion The 3D vision revealed an important advantage in order to achieve the correct identification of surgical anatomy allowing a safe and effective right colectomy with CME, CVL, and intracorporeal anastomosis, either using laparoscopic or with robotic approach, providing similar short-term outcomes. Taking into account the high costs and the longer operative time of robotic procedure, the 3D laparoscopy could be considered in performing right colectomy with CME, while the robotic approach should be considered as a first choice approach for challenging situations (obese patient, complex associated procedures).
机译：背景：我们描述了我们在右结肠癌的完全结肠系膜切除术（CME）、中央血管结扎术（CVL）和体内吻合术中的初步经验，比较了机器人和三维（3D）腹腔镜方法。方法我们对2014年1月至2019年6月接受右半结肠癌根治性手术切除伴CME的患者进行回顾性观察性临床队列研究。倾向评分通过双变量逻辑回归计算，包括以下变量：年龄、BMI和肿瘤大小。结果55例CVL患者接受了CME治疗：26例采用机器人辅助手术，29例采用3D腹腔镜手术。在所有术中和术后结果（手术时间、标本长度、肠道插管时间、口腔软性进食时间、住院时间、术后并发症、取回的淋巴结数量、阳性淋巴结数量和淋巴结比率）方面，机器人和3D腹腔镜手术之间没有统计学显著差异。匹配程序完成后，选择机器人组和3D腹腔镜组的20名患者进行分析。除机器人组手术时间较长外，两组之间的任何分析变量均无差异（p=0.002）。结论3D视觉在正确识别外科解剖结构方面显示了重要的优势，可以安全有效地进行右半结肠切除术，采用CME、CVL和体内吻合，无论是采用腹腔镜还是采用机器人方法，提供类似的短期结果。考虑到机器人手术的高成本和较长的手术时间，3D腹腔镜可用于进行CME右结肠切除术，而机器人手术应被视为具有挑战性的情况（肥胖患者、复杂的相关手术）的首选方法。

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