美国休斯顿德克萨斯大学健康科学中心麦戈文医学院Oscar A Olavarria比较了机器人与腹腔镜腹部疝修补术的疗效。2020年7月14日，《英国医学杂志》发表了这项成果。

为了确定与腹腔镜手术相比，机器人腹部疝修补术后90天能否减少住院天数，研究组在美国休斯敦的多学科疝气诊所进行了一项实用、盲法、随机对照试验。2018年4月至2019年2月，共招募了124例择期行微创腹部疝修补术的参与者，将其随机分组，其中65例接受机器人腹部疝修补术，59例接受腹腔镜腹部疝修补术。主要结局为术后90天内的住院天数。

两组患者的基线特征相似。123位患者完成了90天的随访。两组患者在术后90天内的中位住院天数均为0天，无显著差异。两组患者的急诊就诊、伤口并发症、疝气复发或再次手术的发生率均无显著性差异。

但机器人修补的手术时间为141分钟，显著长于腹腔镜手术（77分钟）；医疗保健平均成本为15865美元，显著高于腹腔镜手术（12955美元）。接受机器人腹部疝修补术的患者中有两名进行了肠切开术，而接受腹腔镜手术的患者则没有。术后1个月，机器人腹部疝修补术组的腹壁生活质量改善中位数为3，腹腔镜腹部疝修补术组为15。

研究组发现机器人腹部疝修补术与腹腔镜修补术相比，并不能减少90天内的住院天数，但增加了手术时间和医疗费用。

附：英文原文

Title: Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Author: Oscar A Olavarria, Karla Bernardi, Shinil K Shah, Todd D Wilson, Shuyan Wei, Claudia Pedroza, Elenir B Avritscher, Michele M Loor, Tien C Ko, Lillian S Kao, Mike K Liang

Issue&Volume: 2020/07/14

Abstract: Objective To determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair.

Design Pragmatic, blinded randomized controlled trial.

Setting Multidisciplinary hernia clinics in Houston, USA.

Participants 124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019.

Interventions Robotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59).

Main outcome measures The primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat.

Results Patients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15865 (￡12746; €14125) v $12955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair.

Conclusion This study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs.

DOI: 10.1136/bmj.m2457

Source: https://www.bmj.com/content/370/bmj.m2457