Tying and Tearing in Robotic and Laparoscopic Intracorporeally Hand-Sewn Ileocolic Anastomoses. A Propensity Score-Matched Prospective Study.

摘要

AIM: The aim of this study was to evaluate the impact of the ergonomics of laparoscopy as well as the lack of tactile feedback in robotic surgery on intracorporeal suturing. METHODS: This was a prospective cohort study that compared the first 12 consecutive robotic hand-sewn ileocolic anastomoses to matched laparoscopic cases performed by the same surgeon. The endpoints were interrupted suturing and tying time, and the numbers of interrupted sutures placed and torn. Propensity score matching was based on age, body mass index, previous abdominal surgery, and diagnosis. Ileocolic anastomoses were hand-sewn in two layers: running 3-0 polyglycolic acid and interrupted 3-0 silk. Continuous variables were compared using the Student t test, whereas a Chi-square test was used to compare categorical variables. Linear regression and a cumulative sum analysis (CUSUM) were used for quality control. RESULTS: Median time for robotic suturing and tying was significantly shorter than that in matched laparoscopic cases (89.5 sec (IQR 76-103.5) vs. 160 sec (IQR 146-210), p<0.0001). There were fewer torn sutures in laparoscopic suturing (1 (IQR 1-2.5) vs. 0 (IQR 0-0.5), p<0.0026). No differences were found in complication rates (6 vs. 2 p=0.19). CUSUM analysis did not show a significant improvement in the number of torn sutures over time. CONCLUSION: Although there were more torn sutures with robotic suturing and tying, significantly less time was required than for laparoscopic intracorporeal suturing. This study suggests that torn sutures may be the result of a lack of tactile feedback rather than the presence of a learning curve.