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首页> 外文期刊>Surgical Endoscopy >Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it?
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Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it?

机译：使用da Vinci机器人系统执行Roux-en-Y胃旁路手术：值得吗？

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BACKGROUND: The Roux-en-Y gastric bypass procedure (RYGBP) is in many countries the gold standard for obtaining long-lasting weight reduction and improvement of obesity-related comorbidities. However, performing this operation by standard laparoscopic techniques requires important surgical skills because of the anastomoses involved. The da Vinci surgical robot system with its enhanced degrees of freedom in motion and three-dimensional vision is designed to overcome the difficulties encountered in traditional laparoscopic surgery with suturing and delicate tissue handling. METHODS: For this study, 45 patients (9 men) with a mean body mass index (BMI) of 44.2 (range, 35.1-55.4) underwent RYGBP with the aid of the da Vinci robot system. They were compared with 45 consecutive patients with a mean BMI of 43.9 (range, 35.1-56.2) who underwent a laparoscopic RYGBP by the same surgeon during the same period. RESULTS: Overall, the total operating time was shorter for the laparoscopic cases (127 vs 212 min; p < 0.05). However, the last 10 robotic cases were performed in the same time span as the laparoscopic cases (136 vs 127 min). The total robotic setup time remained constant at about 30 min. There were no differences in postoperative complications between the two groups in terms of anastomotic leakage or stenosis. In the robotic group, more conversions to open surgery were noted. Early in the study, four patients (9%) had to undergo conversion to standard laparoscopic techniques due to inadequate setup of the robotic arms. Five patients (11%), however, had to undergo conversion to open surgery because of intestinal laceration during manipulation of the intestines with the robotic instruments. The costs were higher for robotic surgery than for standard laparoscopic RYGBP, mainly because of the extra equipment used, such as ultrasonic devices. CONCLUSION: The RYGBP procedure can be performed safely with the da Vinci robot after a learning curve of about 35 cases. At this writing, however, it is not clear whether the da Vinci system offers a real advantage over standard laparoscopic techniques.
机译：背景：Roux-en-Y胃旁路手术（RYGBP）在许多国家/地区是长期减肥和改善与肥胖相关的合并症的金标准。然而，由于所涉及的吻合术，通过标准腹腔镜技术执行该手术需要重要的手术技能。达芬奇外科手术机器人系统具有增强的运动自由度和三维视觉，旨在克服传统腹腔镜手术在缝合和精细组织处理方面遇到的困难。方法：对于本研究，在达芬奇机器人系统的帮助下，对45名平均体重指数（BMI）为44.2（范围为35.1-55.4）的患者（9名男性）进行了RYGBP。将他们与同一位外科医生在同一时期接受腹腔镜RYGBP的45例平均BMI为43.9（范围35.1-56.2）的连续患者进行比较。结果：总体而言，腹腔镜手术的总手术时间较短（127比212分钟; p <0.05）。但是，最后10个机器人病例是在与腹腔镜病例相同的时间范围内进行的（136对127分钟）。机械手的总安装时间保持恒定在大约30分钟。两组吻合口漏或狭窄的术后并发症无差异。在机器人组中，注意到有更多的人转向开放手术。在研究的早期，由于机械臂设置不充分，四名患者（9％）不得不接受标准腹腔镜技术的转换。但是，有5名患者（11％）由于使用机器人器械操作肠子时出现肠裂伤而不得不接受开腹手术。机器人手术的费用比标准腹腔镜RYGBP的费用高，这主要是因为使用了额外的设备，例如超声波设备。结论：达芬奇机器人可以在大约35例学习曲线后安全地执行RYGBP程序。但是，在撰写本文时，尚不清楚达芬奇系统是否比标准腹腔镜技术具有真正的优势。

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