| Objective:To compare the short-term clinical efficacy of robot-assisted laparoscopic surgery and traditional laparoscopic surgery in the treatment of gynecological diseases in overweight and obese patients,explore the feasibility,safety and effectiveness of the robotic surgical system for gynecological surgery in overweight and obese patients,and analyze the advantages,so as to provide objective decision-making basis for the rational selection of surgical methods for overweight and obese patients.Methods:A total of 401 cases of benign gynecological diseases(223 cases of small uterus and 178 cases of large uterus)and 625 cases of malignant diseases(340 cases of cervical cancer and 285 cases of endometrial cancer)admitted to the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Gannan Medical College from August 2015 to November 2022 were retrospectively collected.The patients were divided into robot surgery group and traditional laparoscopic surgery group according to the surgical method,and each surgery group was divided into three subgroups according to Body Mass Index(BMI): normal group(18.50≤BMI <24.00),overweight group(24.00≤BMI<28.00),and obese group(28.00≤BMI).All the operations of the above enrolled patients were performed by the same gynecologist.The basic data,intraoperative indicators(operation time,intraoperative blood loss,intraoperative blood transfusion rate,conversion rate,number of lymph nodes removed,and incidence of intraoperative complications),postoperative indicators(postoperative anal exhaust time,postoperative hospital stay,pelvic drainage tube extraction time,incidence of deep vein thrombosis,incidence of postoperative complications),and economic indicators(surgical cost)wereanalyzed and compared,total hospitalization costs).Results:1.The basic information of age,BMI,etiology,previous history of abdominal surgery,preoperative complications,and size of uterus ratio of the two groups of patients with benign disease were compared,and the differences were not statistically significant;The differences in age,BMI,previous abdominal operation history,preoperative complications and other basic databetween cervical cancer and endometrialcancer were not statistically significant.2.Comparison of indicators between robotic and conventional laparoscopy in benign diseases(1)Comparison of various indexes of small uterus using robot and traditional laparoscopyThe normal group(1.83(1.67,2.00)h vs 1.42(1.17,1.61)h),overweight group(1.75(1.50,1.88)h vs 1.50(1.25,1.75)h)took longer than conventional laparoscopic surgery,Less intraoperative bleeding volume(10.00(10.00,20.00)ml vs 10.00(10.00,50.00)ml),Postoperative anal exhaust time((1.88±0.32)d vs(2.04±0.27)d)was shorter,Surgical cost of each subgroup in robotic surgery(normal group:(2.24±0.28)ten thousand yuan vs(0.90±0.15)ten thousand yuan,overweight group: 2.31(2.24,2.36)ten thousand yuan vs 0.86(0.73,1.05)ten thousand yuan,obese group:(2.26±0.34)ten thousand yuan vs(2.94±0.20)ten thousand yuan),total hospitalization expenses(normal group: 3.23(3.04,3.42)ten thousand yuan vs 2.00(1.85,2.24)ten thousand yuan),overweight group:(3.20±0.32)ten thousand yuan vs(2.11±0.34)ten thousand yuan,obese group:(3.31±0.35)ten thousand yuan vs(2.06±0.26)tenthousand yuan)were higherthan the traditional laparoscopicsurgery group,P<0.05,All of the differences were statistically significant.There was no significant difference in intraoperative bleeding and anal exhaust time between overweight group and obese group in robot surgery and traditional laparoscopic surgery(P> 0.05),There was no significant difference in Operation time of obese group in robot surgery and traditional laparoscopic surgery(P> 0.05),robot surgery in intraoperative complications,open rate,intraoperative blood transfusion,postoperative complications,deep vein thrombosis,postoperative hospital time have no significant difference compared with traditional laparoscopicsurgery(P> 0.05).(2)Comparison of various indexes of largeuterus using robot and traditional laparoscopyThe intraoperative bleeding volume in each subgroup of robotic surgery was compared with conventional laparoscopic surgery(normal group: 10.00(10.00,50.00)ml vs50.00(20.00,200.00)ml,overweight group: 20.00(10.00,50.00)ml vs 65.00(20.00,100.00)ml,obese group: 25.00(10.00,100.00)ml vs 50.00(20.00,100.00)ml)was less,operation cost was higher(normal group:(2.27±0.35)ten thousand yuan vs(0.98 ±0.18)ten thousand yuan,overweight group :(2.22±0.40)ten thousand yuan vs(0.95±0.20)ten thousand yuan,obesegroup: 2.36(2.24,2.46)ten thousand yuan vs 1.01(0.81,1.11)ten thousand yuan),The total hospitalization cost was higher(normal group:(3.34±0.40)ten thousand yuan vs(2.29±0.39)ten thousand yuan,overweight group:(3.23±0.48)ten thousand yuan vs(2.10±0.23)ten thousand yuan,obese group:(3.33 ±0.37)ten thousand yuan vs(2.39 ±0.50)ten thousand yuan),Lower postoperative anal exhaust time in the normal group in robotic surgery compared with conventional laparoscopic surgery(2.00(2.00,2.00),(1.90 ± 0.55)d vs2.00(2.00,2.00),(2.15±0.61)d),P<0.05,All of the differences were statistically significant.There was no significant difference in postoperative anal exhaust time between overweight group and obese group in robot surgery and traditional laparoscopic surgery(P> 0.05),There was no significant difference in robot surgery in operation time,intraoperative complications,open rate,intraoperative blood transfusion rate,postoperative incidence of deep vein thrombosis,postoperative hospital stay compared with thetraditional laparoscopic surgery(P>0.05).3.Comparison of indicators between robotic and conventional laparoscopy in malignant diseases(1)Comparison of various indexes of cervical cancer using robot and traditional laparoscopyThe operation time of each subgroup in robotic surgery was compared with that of conventional laparoscopic surgery(normal group: 5.83(4.83,6.58)h vs 5.36(4.67,5.90)h,overweight group:(5.71±0.99)h vs(5.22±0.72)h,Obese group:5.59(5.25,6.00)h vs 5.13(4.80,5.60)h was longer,Intraoperative bleeding(normal group: 100.00(20.00,200.00)ml vs 200.00(100.00,300.00)ml,overweight group: 150.00(20.00,200.00)ml vs 200.00(57.50,300.00)ml,Obese group: 100.00(27.50,200.00)ml vs 150.00(100.00,200.00)ml)was less,The number of total lymph removed(normal group:53.00(45.00,64.00)vs 42.00(34.25,46.00),overweight group: 56.00(46.25,65.75))vs 39.50(35.00,49.25),Obese group:(57.89 ± 11.84)vs(41.23 ±8.97))was more,Postoperative anal exhaust time(normal group:(2.07 ± 0.32)d vs(2.35 ±0.59)d,overweight group:(1.98 ± 0.36)d vs(2.41 ± 0.63)d,Obese group: 2.00(2.00,2.00)d vs 2.00(2.00,3.00)d)was earlier,Theth of stay(normal group:(7.85 ± 2.00)d vs(9.75 ± 3.63)d,overweight group(7.55 ± 2.10)d vs(8.91 ± 2.74)d,Obese group: 6.00(5.00,7.00)d vs7.00(6.60,9.00)d)was shorter,Operation cost(normal group:(2.88 ± 0.23)ten thousand yuan vs.(1.17 ± 0.15)ten thousand yuan,overweight group:(2.90 ± 0.13)ten thousand yuan vs(1.14 ± 0.14)ten thousand yuan),Obese group:(3.13 ± 0.11)ten thousand yuan vs(1.15 ±0.12)ten thousand yuan)and total hospitalization expenses(normal group:(4.65 ± 0.34)ten thousand yuan vs(3.07 ± 0.46)ten thousand yuan,overweight group:(4.79 ± 0.53)ten thousand yuan vs(2.96 ± 0.41)ten thousand yuan,Obese group:(4.91 ± 0.64)ten thousand yuan vs(3.07 ± 0.50)ten thousand yuan)was higher,P<0.05,All of the differences were statistically significant.In robotic surgery,the subgroups showed no significant difference from traditional laparoscopic surgery in terms of intraoperative complications,transit laparotomy,intraoperative blood transfusion,time of pelvic drainage tube removal,postoperativecomplications,anddeep vein thrombosis(P> 0.05).(2)Comparison of various indexes of endometrial cancer using robot and traditional laparoscopyIn robotic surgery,the number of para-aortic lymph nodes removed(normal group: 21.50(15.00,28.00)vs 14.00(11.00,18.75),overweight group: 23.00(15.00,30.50)vs 16.00(11.00,22.00),Obese group: 19.00(15.50,25.00)vs 14.00(7.00,19.00)),number of total lymph nodes(normal group: 63.50(48.00,78.00)vs 49.00(40.75,56.00),overweight group63.00(52.50,78.50)vs 56.00(43.00,68.25),Obese group: 65.00(60.00,73.00)vs 51.00(39.00,58.00))were more than conventional laparoscopic surgery,Operation cost(normal group:(2.77 ± 0.50)ten thousand yuan vs(1.13 ± 0.15)tenthousand yuan,overweight group:(2.86 ± 0.28)ten thousand yuan vs(1.16 ± 0.14)ten thousand yuan),Obese group:(2.87 ±0.28)ten thousand yuan vs(1.16 ± 0.15)ten thousand yuan),total hospitalization expenses(normal group:(4.70 ± 0.057)ten thousand yuan vs(3.09 ± 0.43)ten thousand yuan,overweight group:(4.77 ± 0.43)ten thousand yuan vs(3.09 ± 0.42)ten thousand yuan,Obese group:(4.85 ± 0.45)ten thousand yuan vs(3.16 ± 0.46)ten thousand yuan)were higher than conventional laparoscopic surgery,In robotic surgery,the operation time in the normal group(4.79(3.99,5.50)h vs 4.16(3.66,4.84)h),overweight group(4.67(4.00,5.54))h vs 4.06(3.67,4.32)h)were longer than the traditional laparoscopic surgery,Postoperative anal exhaust in the overweight group(2.00(2.00,2.00)(2.01±0.39)d vs 2.00(2.00,2.00)(2.14±0.35)d)and obese group((1.98 ± 0.35)d vs(2.36 ±0.67)d)was shorter,postoperative hospital stay(overweight group: 7.00(6.00,6.90)(2.06 ± 8.50)d vs 8.00(7.00,9.00)d,Obese group:(6.54± 0.87)d vs(8.00 ± 2.64)d)was shorter,Less intraoperative bleeding in the obese group during robotic surgery than in conventional laparoscopic surgery(50.00(50.00,125.00)ml vs100.00(50.00,200.00)ml),P<0.05,All of the differences were statistically significant.There was no significant difference in operation time of obese group in robotic surgery compared with conventional laparoscopic surgery(P>0.05),There were no significant differences in postoperative anal exhaust time and postoperative hospital stay of normal group in robotic surgery and conventional laparoscopic surgery(P>0.05),and there were no significant differences in intraoperative blood loss between the normal group and the overweight group in the robotic surgery and the traditional laparoscopic surgery(P>0.05).There were no significant differences in the incidence of intraoperative complications,the rate of conversion to laparotomy,the rate of intraoperative blood transfusion,the time of pelvic drainage tube removal,the incidence of postoperative complications,and the incidence of deep vein thrombosis in all subgroups of robotic surgery compared with traditional laparoscopic surgery(P>0.05).Conclusion:1.Both surgical methods are safe and effective in the treatment of benign and malignant gynecological diseases.Although the cost of robotic surgery is high,it has achieved better perioperative results than traditional laparoscopic surgery on the basis of ensuring surgical safety.2.In the operation of gynecological benign diseases,compared with traditional laparoscopic surgery,robot surgery has advantages of less intraoperative bleeding and shorter postoperative anal exhaust time,and has more obvious advantages in the application of large uterus withoverweight and obesepatients.3.In cervical cancer surgery,compared with traditional laparoscopic surgery,the subgroups of robotic surgery have the advantages of less intraoperative blood loss,more lymph nodes removed,earlier postoperative anal exhaust time,and shorter postoperative hospital stay,and do not increase the cost of overweight and obese patients,so as to ensure the safety andeffectiveness of surgery,but also have potential health and economicvalue.4.In endometrial cancer surgery,compared with traditional laparoscopic surgery,robotic surgery has the advantages of more para-aortic lymph nodes and more total lymph nodes removed in the normal group.In addition to the above advantages,overweight and obese groups also have the advantages of earlier postoperative anal exhaust time and shorter postoperative hospital stay,and the obese group also has less intraoperative blood loss.Robotic surgery has obvious advantages over traditional laparoscopic surgery in the treatment ofoverweight andobese patients with endometrial cancer. |
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