导读：接受机器人辅助完成的肾脏或者前列腺手术的患者术后住院时间更短，且接受输血或者死亡的风险显著降低，但是与此同时，这样的手术所需的费用也比较昂贵，通常要比传统手术高几千美元。
一项发表在Journal of Urology期刊上的新研究发现：接受机器人辅助完成的肾脏或者前列腺手术的患者术后住院时间更短，且接受输血或者死亡的风险显著降低，但是与此同时，这样的手术所需的费用也比较昂贵。
研究人员将越来越普遍的机器人手术与其它两种应用不同技术的同类手术进行比对后发现，机器人手术的直接成本要比其它手术高几千美元。
机器人手术一向被医学界誉为创伤小、效率高，它们通常采用腹腔镜或者“钥匙孔手术”方案，即手术工具和微型摄像头会从1~2个小切口伸进患者体内。
机器人用其机械手臂末端的超精密仪器取代了外科医生的手，外科医生则通过控制台来操纵机器人的所有动作。
Jim Hu在波士顿布里格姆妇女医院接受采访时说：“我们的研究证实，与开放、腹腔镜手术相比，机器人手术的结果的确表现出一定的优势。”
为了弄清楚价格高昂的机器人手术是否真能物有所值，Hu和他的团队对国家政府数据库中的外科手术数据进行了分析。
在2008年的最后3个月间——研究人员所能获取到的最近的、可以用来比对机器人、开放和腹腔镜手术数据的时间——超过一半的前列腺切除手术都涉及到机器人的辅助。
复健时间缩短
据统计，大约3%的前列腺患者选择接受标准腹腔镜手术，44%的接受开放手术。而在肾脏修复或切除手术中，开放手术和腹腔镜手术仍然要远比机器人手术普遍得多。
在接受前列腺切除手术的患者中，腹腔镜手术和机器人手术的死亡率为0，而开放手术的死亡率为千分之二。
接受开放手术的男性中约有5%需要接受输血，而接受机器人辅助手术且需要输血的男性则不足2%。另外，开放手术组的住院时间也要比机器人手术组长1天。
这个结果同样适用于肾脏切除手术。
机器人手术切除前列腺平均需要花费$10,000，约比腹腔镜手术贵$700，比开放手术贵$1100。
而对肾脏切除手术而言，机器人手术需花费$13,900，分别比开放和腹腔镜手术高$1300和$2700。
Use, Costs and Comparative Effectiveness of Robotic Assisted, Laparoscopic and Open Urological Surgery
Hua-yin Yu, Nathanael D. Hevelone, Stuart R. Lipsitz, Keith J. Kowalczyk, Jim C. Hu
Purpose: Although robotic assisted laparoscopic surgery has been aggressively marketed and rapidly adopted, there are few comparative effectiveness studies that support its purported advantages compared to open and laparoscopic surgery. We used a population based approach to assess use, costs and outcomes of robotic assisted laparoscopic surgery vs laparoscopic surgery and open surgery for common robotic assisted urological procedures.
Materials and Methods: From the Nationwide Inpatient Sample we identified the most common urological robotic assisted laparoscopic surgery procedures during the last quarter of 2008 as radical prostatectomy, nephrectomy, partial nephrectomy and pyeloplasty. Robotic assisted laparoscopic surgery, laparoscopic surgery and open surgery use, costs and inpatient outcomes were compared using propensity score methods.
Results: Robotic assisted laparoscopic surgery was performed for 52.7% of radical prostatectomies, 27.3% of pyeloplasties, 11.5% of partial nephrectomies and 2.3% of nephrectomies. For radical prostatectomy robotic assisted laparoscopic surgery was more prevalent than open surgery among white patients in high volume, urban hospitals (all p ≤0.015). Geographic variations were found in the use of robotic assisted laparoscopic surgery vs open surgery. Robotic assisted laparoscopic surgery and laparoscopic surgery vs open surgery were associated with shorter length of stay for all procedures, with robotic assisted laparoscopic surgery being the shortest for radical prostatectomy and partial nephrectomy (all p <0.001). For most procedures robotic assisted laparoscopic surgery and laparoscopic surgery vs open surgery resulted in fewer deaths, complications, transfusions and more routine discharges. However, robotic assisted laparoscopic surgery was more costly than laparoscopic surgery and open surgery for most procedures.
Conclusions: While robotic assisted and laparoscopic surgery are associated with fewer deaths, complications, transfusions and shorter length of hospital stay compared to open surgery, robotic assisted laparoscopic surgery is more costly than laparoscopic and open surgery. Additional studies are needed to better delineate the comparative and cost-effectiveness of robotic assisted laparoscopic surgery relative to laparoscopic surgery and open surgery.
文献链接：https://www.sciencedirect.com/science/article/pii/S0022534711057673
