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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急诊机器人手术：单中心经验及文献综述


腹腔镜手术广泛应用于腹部急诊手术（AES），将这种方法扩展到最近的机器人手术（RS）的可能性引起了人们的极大兴趣。机器人技术的缓慢普及主要是由于高成本和与腹腔镜手术相比较长的 RS 手术时间可能会成为阻碍因素，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、转换率和手术学习曲线。通过广泛的文献综述，我们的数据也与其他经验进行了比较。我们回顾性分析了过去 10 年的单个外科医生系列。 2014年1月至2023年12月，36名患者接受了紧急或急诊RS。使用的机器人设备为Da Vinci Si（15例）和Xi（21例）。我们的分析包括 834 例机器人手术中的 36 例 (4.3%)：20 例 (56.56%) 女性。平均年龄为 63 岁，30% 的患者≥ 70 岁。 2 次（5.55%）手术在夜间进行。本系列中没有报告打开的转化。根据Clavien-Dindo分类，主要并发症有2例（5.5%）。术中和 30 天死亡率均为 0%。我们的研究表明，当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 治疗时，RS 可能也是治疗 AES 和术中腹腔镜并发症的一种有用且可靠的方法。该技术可以通过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。