机器人辅助胃旁路手术效果理想

圣迭戈——迄今最大规模的机器人辅助胃旁路手术多中心研究显示，该手术后30天时的死亡率为0，并且瘘和脓肿的发生率仅为0.3%。

德克萨斯大学医学中心的Wilson博士及其合作者对2003年2月~2011年9月间使用Vinci手术系统(Intuitive Surgical)进行的1,695例机器人辅助Roux-en-Y胃旁路手术进行了回顾分析。手术在以下3个中心进行：德克萨斯大学医学中心(578例)、东缅因州医学中心(708例)和佛罗里达州Celebration Health医院(409例)。患者的平均体重指数(BMI)为48.9 kg/m2，研究者对手术后30天内的并发症和预后进行了评估。

Erik Wilson博士

结果显示，患者平均住院时间为2.2天，在术后30天内，有81例患者再次住院(4.8%)，“这与在一般人群中的预期差别不大。”其中，49例(2.9%)住院原因为脱水，27例(1.6%)为恶心/呕吐，5例(0.3%)为狭窄需要扩张。

有46例患者在术后30天内再次手术(2.7%)。其中，18例(1.06%)再次手术的原因为肠梗阻/疝、17例(1%)为出血/血肿、6例(0.35%)为外科医生对探查阴性结果感到担心，5例(0.29%)为脓肿/瘘。共发生26例早期主要并发症(1.5%)。其中，14例 (0.83%)为需输血治疗的出血，5例(0.29%)为狭窄需要扩张，3 例(0.18%)为脓肿，2例 (0.12%)为吻合口瘘，2 例(0.12%)为肺栓塞/梗死。无患者死亡，“我们认为结果非常理想”。

各中心的平均手术时间不同，德克萨斯中心为156分钟，佛罗里达中心为128分钟，缅因中心为104分钟。“随着时间推移和技术熟练，手术时间将进一步缩短，目前已缩短至接近90分钟，”Wilson医生说。

Wilson医生披露担任Intuitive Surgical,、爱惜康内镜外科公司、Apollo Endosurgery和 EndoGastric Solutions公司的顾问，还担任Intuitive Surgical公司的代言人，并接受了Gore提供的教育津贴。

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By: DOUG BRUNK, Clinical Endocrinology News Digital Network

SAN DIEGO – At 30 days, the mortality rate from robotic-assisted gastric bypass surgery was zero and the rate of leak or abscess was just 0.3%, a multicenter study showed.

"Complications are few and may be less than with conventional laparoscopic techniques, even in different centers," Dr. Erik B. Wilson said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.

In what he said is the largest reported series of its kind, Dr. Wilson and his associates reviewed 1,695 robotic-assisted Roux-en-Y gastric bypass procedures performed with the da Vinci Surgical System (Intuitive Surgical) between February 2003 and September 2011. The operations were performed at three centers: the University of Texas Health Science Center at Houston (578 procedures), Eastern Maine Medical Center, Bangor (708 procedures), and Florida Hospital Celebration Health (409). The mean body mass index of patients was 48.9 kg/m2, and the researchers evaluated complications and outcomes that occurred within the first 30 days of surgery.

Dr. Wilson, associate professor of surgery at the University of Texas Health Science Center at Houston, reported that the average length of stay was 2.2 days. Within the first 30 days of surgery there were 81 readmissions (4.8%), "which is not too different from what you’d expect in most populations," he said. Of these, 49 (2.9%) were for dehydration, 27 (1.6%) were for nausea/vomiting, and 5 (0.3%) were for stricture requiring dilation.

There were 46 reoperations (2.7%) within the first 30 days of surgery. Of these, 18 (1.06%) were for bowel obstruction/hernia, 17 (1%) were for bleeding/hematoma, 6 (0.35%) were for negative exploration of patients the surgeons were concerned about, and 5 (0.29%) were for abscess/leak.

There were 26 early major complications (1.5%). Of these, 14 (0.83%) were bleeding requiring transfusion, 5 (0.29%) were stricture requiring dilation, 3 (0.18%) were abscesses, 2 (0.12%) were anastomotic leaks, and 2 (0.12%) were cases of pulmonary embolism/infarct. There was no mortality, "which we think is very favorable," Dr. Wilson said.

Average operating times varied by center: 156 minutes in Houston, 128 minutes in Florida, and 104 minutes in Maine. "As time has gone on, and as we engage each other on how we do things, these operative times have continued to decrease, with current times approaching 90 minutes," Dr. Wilson said. "So long operative times are not necessary when you do robotic surgery."

He concluded by describing robotic-assisted bypass surgery as "an enabling technology that allows for excellent reproducible outcomes, because we have multiple centers doing it well. Future studies should focus on revisional and more complex procedures such as biliopancreatic conversion."

Dr. Wilson disclosed that he is a consultant for Intuitive Surgical, Ethicon Endo-Surgery, Apollo Endosurgery, and EndoGastric Solutions. He is also a proctor for Intuitive Surgical, and has received an educational grant from Gore.