ImportanceAlthough robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.ObjectivesTo describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.Design, Setting, and ParticipantsA retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included.ExposureSurgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair.Main Outcomes and MeasuresThe primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups.ResultsDuring the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (−0.48 [95% CI, −0.60 to −0.35] days), inguinal hernia repair (−0.20 [95% CI, −0.30 to −0.10] days), and ventral hernia repair (−0.16 [95% CI, −0.26 to −0.06] days).Conclusions and RelevanceWhile robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.

中文翻译：

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微创手术时代机器人技术在急诊普外科病例中的应用

重要性虽然机器人手术已成为广泛的择期手术的既定方法，但有关其实用性和结果的数据在紧急普通手术中仍然有限。目的描述腹腔镜和机器人方法使用的时间趋势，并比较机器人和机器人之间的结果腹腔镜手术用于 4 种常见的紧急外科手术。设计、设置和参与者从 2013 年到 2021 年，对美国 829 个机构的全付费出院数据库进行了回顾性队列研究。数据分析是从 2022 年 7 月到 2023 年 11 月进行的。总计 1 067 263 例紧急或紧急胆囊切除术 (n = 793 800)、结肠切除术 (n = 89 098)、腹股沟疝修补术 (n = 65 039) 和腹疝修补术 (n = 119 326)，患者年龄为 18 岁或以上暴露手术方法（机器人、腹腔镜或开放）紧急或紧急胆囊切除术、结肠切除术、腹股沟疝修补术或腹疝修补术。主要结果和措施主要结果是每种手术方法（腹腔镜、机器人，或开放）。次要结局包括转为开放手术和住院时间（总住院时间和术后住院时间）。使用线性回归测量时间趋势。使用倾向评分匹配来比较机器人手术组和腹腔镜手术组之间的次要结果。结果在研究期间，所有手术中机器人手术的使用率均逐年显着增加：胆囊切除术为 0.7%，结肠切除术为 0.9%，结肠切除术为 1.9%腹股沟疝修补术，1.1%用于腹疝修补术。所有病例的开放手术入路均相应减少。与腹腔镜手术相比，机器人手术与转开腹手术的风险显着降低相关：胆囊切除术，1.7% vs 3.0%（比值比 [OR]，0.55 [95% CI，0.49-0.62]）；结肠切除术，11.2% vs 25.5%（OR，0.37 [95% CI，0.32-0.42]）；腹股沟疝修补术，2.4% vs 10.7%（OR，0.21 [95% CI，0.16-0.26]）；腹疝修补术，3.5% vs 10.9%（OR，0.30 [95% CI，0.25-0.36]）。机器人手术与结肠切除术（-0.48 [95% CI，-0.60 至 -0.35] 天）、腹股沟疝修补术（-0.20 [95% CI，-0.30 至 -0.10] 天）和较短的术后住院时间相关。腹疝修补术（−0.16 [95% CI，−0.26 至 −0.06] 天）。结论和相关性虽然机器人手术仍未广泛用于急诊普通手术，但本研究的结果表明它正变得越来越普遍，并且可能与通过减少转向开放手术和缩短住院时间来衡量，效果更好。