| The aim of present study is to compare the short-term outcomes among RATG,2D-LATG and 3D-LATG.We retrospectively collected 61cases of RATG,211 cases of 2D-LATG and 49 cases of 3D-LATG.We defined BMI?24 kg/m2 as overweight and defined BMI<23.9 as non-overweight.Short term outcomes among 3 methods were compared in overweight and non-overweight conditions.Short term outcomes between overweight and non-overweight conditions were also compared in the three methods respectively.The three methods showed no significant difference in preoperative baseline conditions and postoperative pathological classifications.Compared with RATG and 3D-LAG,2D-LATG took shorter operative time(RATG=273.4±59.0min,2D-LATG=243.4±64.1min,3D-LATG=275.2±62.4min,p=0.000)and pneumoperitoneal time[RATG=140.0(91.0,234.0)min,2D-LATG=116.0(45.0,259.0)min,3D-LATG=154.5(70.0,312.0)min,p=0.023].The robot cost most[RATG=163098(100469,171955)yuan,2D-LATG=89171(43629,250860)yuan,3D-LATG=105024(65024,181939)yuan,p=0.000].In RATG cases,the overweight took longer operative time than the non-overweight[280.0(205.0,360.0)min vs.250.0(153.0,360.0)min,p=0.001]but dissected less lymph nodes[2(0,19)vs.6(0,36),p=0.025].In2D-LATG,overweight group had more blood loss[200(50,1800)ml vs.150(50,1200)ml,p=0.003]and took longer operative time[250.0(129.0,420.0)min vs.225.0(123.0,520.0)min,p=0.018].In non-overweight condition,3D-LATG took longest operative time[RATG=257.5(205.0,360.0)min,2D-LATG=230.0(147.0,520.0)min,3D-LATG=272.5(180.0,410.0)min,p=0.001],had the largest drainage in the first postoperative day(RATG=146.7±1 01.3ml,2D-LATG=186.0±139.3ml,3D-LATG=219.6± 144.1ml,p=0.030)and the shortest postoperative hospital stay[RATG=13.5(10.0,23.0)days,2D-LATG=15.9(10.0,44.0)days,3D-LATG=10.5(9.0,11.0)days,p=0.000].RATG cost the most(RATG=143477±26820yuan,2D-LATG=102319±41193yuan,3D-LATG= 100772±21199yuan,p=0.000).In overweight condition,RATG took longest operative time[RATG=280.0(205.0,495.0)min,2D-LATG=250.0(129.0,420.0)min,3D-LATG=270.0(180.0,360.0)min,p=0.002]and cost most[RATG=150105(111223,521236)yuan,2D-LATG=94026(54562,157161)yuan,3D-LATG=101589(65024,181939)yuan,p=0.000].In all the 3 methods,there were significant correlation between operative time and pneumoperitoneal time and between postoperative hospital stay and total cost(p<0.05).In 2D-LATG and 3D-LATG,there were significant correlation between operative time and blood loss and between total dissected lymph nodes and dissected metastatic lymph nodes(p<0.05).In RATG and 2D-LATG,there were significant correlation between total cost and operative time.In RATG,there were significant correlation between operative time and BMI,between blood loss and postoperative hospital stay,between blood loss and total cost and between total dissected lymph nodes and open procedure time(p<0.05).In 2D-LATG,there were significant correlation between operative time and open procedure time,between pneumoperitoneal time and blood loss,between total dissected lymph nodes and blood loss,between dissected metastatic lymph nodes and total cost,between metastatic lymph nodes and blood loss and between BMI and blood loss(p<0.05).In 3D-LATG,there were significant correlation between BMI and postoperative hospital stay.3D-LATG should be considered independent from RATG and 2D-LATG.3D-LATG contributes to more focused attention and better lymphadenectomy and is less vulnerable to the change of BMI than RATG and 2D-LATG.In non-overweight condition,3D-LATG is the most cost-effectiveness.When overweight,the advantage of 3D-LATG over RATG and 2D-LATG is weaken.BMI should be taken into comprehensive consideration to select optimal minimally invasive surgical method. |
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