Performance with robotic surgery versus 3D- and 2D-laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials.

Autor: Zwart MJW; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., Jones LR; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands. l.r.jones@amsterdamUMC.nl.; Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. l.r.jones@amsterdamUMC.nl., Fuente I; Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Balduzzi A; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands.; General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy., Takagi K; Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Okayama University, Okayama, Japan., Novak S; Department of Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Stibbe LA; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., de Rooij T; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., van Hilst J; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., van Rijssen LB; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., van Dieren S; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., Vanlander A; Department of Surgery, University Hospital Ghent, University of Ghent, Ghent, Belgium., van den Boezem PB; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Daams F; Department of Surgery, Amsterdam UMC, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands., Mieog JSD; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Rosman C; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Festen S; Department of Surgery, OLVG, Amsterdam, The Netherlands., Luyer MD; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Lips DJ; Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Moser AJ; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Busch OR; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands., Abu Hilal M; Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Hogg ME; Department of Surgery, Northshore University Health System, Chicago, IL, USA., Stommel MWJ; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Besselink MG; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, The Netherlands. m.g.besselink@amsterdamUMC.nl.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2022 Jun; Vol. 36 (6), pp. 4518-4528. Date of Electronic Publication: 2021 Nov 19.
DOI: 10.1007/s00464-021-08805-3
Abstrakt: Background: Robotic surgery may improve surgical performance during minimally invasive pancreatoduodenectomy as compared to 3D- and 2D-laparoscopy but comparative studies are lacking. This study assessed the impact of robotic surgery versus 3D- and 2D-laparoscopy on surgical performance and operative time using a standardized biotissue model for pancreatico- and hepatico-jejunostomy using pooled data from two randomized controlled crossover trials (RCTs).
Methods: Pooled analysis of data from two RCTs with 60 participants (36 surgeons, 24 residents) from 11 countries (December 2017-July 2019) was conducted. Each included participant completed two pancreatico- and two hepatico-jejunostomies in biotissue using 3D-robotic surgery, 3D-laparoscopy, or 2D-laparoscopy. Primary outcomes were the objective structured assessment of technical skills (OSATS: 12-60) rating, scored by observers blinded for 3D/2D and the operative time required to complete both anastomoses. Sensitivity analysis excluded participants with excess experience compared to others.
Results: A total of 220 anastomoses were completed (robotic 80, 3D-laparoscopy 70, 2D-laparoscopy 70). Participants in the robotic group had less surgical experience [median 1 (0-2) versus 6 years (4-12), p < 0.001], as compared to the laparoscopic group. Robotic surgery resulted in higher OSATS ratings (50, 43, 39 points, p = .021 and p < .001) and shorter operative time (56.5, 65.0, 81.5 min, p = .055 and p < .001), as compared to 3D- and 2D-laparoscopy, respectively, which remained in the sensitivity analysis.
Conclusion: In a pooled analysis of two RCTs in a biotissue model, robotic surgery resulted in better surgical performance scores and shorter operative time for biotissue pancreatic and biliary anastomoses, as compared to 3D- and 2D-laparoscopy.
(© 2021. The Author(s).)
Databáze: MEDLINE
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