机器人辅助手术在减重代谢外科中的应用与展望

Review and outlook on the application of robotic‑assisted bariatric and metabolic surgery

  • 摘要: 机器人辅助手术(RAS)作为减重代谢外科的重要技术拓展,其临床应用价值与未来发展前景值得深入探讨。现有证据表明:机器人辅助袖状胃切除术与Roux‑en‑Y胃旁路术安全可行,在超级肥胖患者中可能凭借其操作精准性降低出血、胃瘘等风险。然而,相关Meta分析结果显示:相较于传统腹腔镜手术,RAS在广泛人群的短期结局中尚未确立普遍优势,且常伴随更长手术时间及更高费用。对于机器人辅助胆胰转流‑十二指肠转位术等复杂手术方式,其学习曲线陡峭,但经验积累后可体现手术价值。在需行修正手术等复杂情况下,RAS显示出良好的短期安全性与操作便利性,但长期疗效证据仍需加强。未来,平台技术发展与人工智能的融合将塑造其前景,但需应对成本与数据挑战。笔者对RAS在减重代谢外科中的应用予以回顾与展望,供同道参考借鉴。

     

    Abstract: Robotic‑assisted surgery (RAS) represents a significant technological advance-ment in bariatric and metabolic surgery, and its clinical utility as well as future development pros-pects merit comprehensive analysis. Current evidence indicates that robotic‑assisted sleeve gastrec-tomy and robotic‑assisted Roux‑en‑Y gastric bypass are both safe and feasible, with the potential for enhanced precision reducing the risks of hemorrhage and gastric leak, particularly in patients with super obesity. However, Meta‑analyses reveal that, when compared to conventional laparoscopic surgery, RAS has yet to establish clear short‑term benefits across broader populations and is frequently associated with longer operative durations and higher costs.For technically demanding procedures such as robotic-assisted biliopancreatic diversion with duodenal switch, a steep learning curve exists, though proficiency can translate into tangible value. In complex revision cases, RAS demonstrates favorable short‑term safety profiles and operative convenience, yet robust evidence for long‑term outcomes remains lacking. The continued advancement of platform technologies and integration with artificial intelligence are anticipated to shape the future landscape of RAS, while cost and data‑related challenges must be addressed. The authors provide a review and outlook on the deployment of RAS in bariatric and metabolic surgery, as a reference for the surgical community.

     

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