Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature review. We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases). 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%. Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach.

中文翻译：

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紧急机器人手术：单一中心的经验和文献综述


腹腔镜手术广泛用于腹部急诊手术 （AES），将这种方法扩展到最近的机器人手术 （RS） 的可能性引起了极大的兴趣。与腹腔镜相比，机器人技术的缓慢传播主要是由于高成本和更长的 RS 手术时间，这可能是抑制因素，尤其是在 AES 中。本研究旨在报告我们在 AES 中使用 RS 的经验，评估其安全性和可行性，特别关注术中和术后并发症、转化率和手术学习曲线。我们还通过广泛的文献综述将我们的数据与其他经历进行了比较。我们回顾性分析了过去 10 年的单个外科医生系列。从 2014 年 1 月到 2023年12月，36 例患者接受了紧急或紧急 RS。使用的机器人设备是达芬奇Si（15例）和习（21例）。我们的分析包括 36 例机器人手术中的 4.3 例 （834%）：20 例 （56.56%） 女性。平均年龄为 63 岁，30% 的患者年龄≥ 70 岁。2 例 （5.55%） 手术在夜间进行。本系列中未报告任何 open 的转化。根据 Clavien-Dindo 分类，收集了 2 例 （5.5%） 主要并发症。术中和 30 天死亡率为 0%。我们的研究表明，在训练有素的机器人中心对选定的血流动力学稳定的患者进行 RS 也可能是一种有用且可靠的 AES 和术中腹腔镜并发症的方法。该技术可能会以完全机器人或混合方法提高紧急情况下的微创使用和转化率。