• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Robotic lobectomy costs and quality of life

    2020-07-30 08:32:46JenniferNishimuraMatthewGoodwinPeterKneuertzSusanMoffattBruceRobertMerrittDesmondSouza
    Mini-invasive Surgery 2020年2期

    Jennifer M.Nishimura, Matthew Goodwin, Peter Kneuertz, Susan Moffatt-Bruce, Robert E.Merritt, Desmond M.D'Souza

    Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.

    Abstract

    Keywords: Robotic, thoracic surgery, lobectomy, cost, quality of life, patient reported outcomes

    INTRODUCTION

    The surgical approach for pulmonary lobectomy has significantly changed over time.Two decades ago, the majority of lobectomies were performed via thoracotomy.Over time, surgeons began to adopt videoassisted thoracoscopic surgery (VATS) and an increased proportion of lobectomies were performed using this minimally invasive approach.The da Vinci Surgical System (Intuitive Surgical; Sunnyvale, California, USA) later provided an alternative platform.The proportion of lobectomies after introduction of this system performed by thoracotomy continued to decline.One study showed that, in 2008, 76.2% of lobectomies were performed using the open approach, compared with 23.4% and < 1.0% for VATS and robotic approaches, respectively[1].In 2014, the majority of lobectomies was no longer performed via the open approach, and VATS and robotic approaches comprised 31.6% and 25.0% of lobectomies, respectively[1].Another study demonstrated that, from 2011 to 2015, lobectomies performed by thoracotomy had an absolute decline of 11.5%[2].Lobectomies performed using the robotic approach had an absolute increase of 10%, yet VATS only had an absolute increase of 1.5%[2].

    While the use of the robotic platform for lobectomy is growing and its safety has been evaluated and found to be acceptable[2-5], additional considerations for utilizing the robotic approach over other techniques and starting a robotic lobectomy program are still under evaluation, including costs and patient reported outcomes (PRO).A systematic review of the literature on the cost of robotic-assisted lobectomy that was performed by Singeret al.[6]from our institution, which included six observational studies published before 1 December 2017, found that, in general, the costs of robotic lobectomy exceed those of VATS.The studies that they reviewed were primarily based on early experiences, with the study period ranging from 2007 to 2013, and were only from the USA.

    In this article, an updated review of the literature of the cost of robotic lobectomy is presented and the quality of life in these patients is reviewed.

    METHODS

    Literature search

    An electronic literature search on PubMed was performed to identify studies that included either robotic lobectomy costs or quality of life on 9 September 2019.Search terms used included: (“cost” or “charges” or “quality of life” or “patient reported outcomes”) AND (“robotic” or “robot”) AND (“l(fā)obectomy” or “anatomic resection”).Abstracts from the search result were screened for relevance to include studies that evaluated costs and/or quality of life in patients undergoing robotic lobectomy.Original articles written in English were selected.Case reports and abstract-only publications were excluded.The full-text of the remaining studies were reviewed for eligibility.Additional studies were identified from reviewing the references of the studies found in the electronic literature search.

    RESULTS

    The literature search for costs associated with robotic lobectomy and review of its references resulted in 16 relevant articles [Table 1] from five different countries (Canada, 1; China, 2; France, 1; Italy, 1; and USA, 11)[1,7-21].These articles were published from 2008 to 2019 with the study period ranging from 2008 to 2017.The number of patients undergoing robotic lobectomy ranged from 12 to 2498.All studies were observational.The majority of studies were retrospective analyses of prospectively collected data from a single institution.Other studies included one prospective observational study[7]and four population-based cohort studies[1,8-10].In addition to analyzing costs of patients undergoing robotic lobectomy, seven of these studies also included patients who underwent robotic segmentectomy or wedge resection[7,9,11,13-15,18].The majority of studies reported using the da Vinci Si system.Only two studies noted the use of the Xi[16,17].Both four-arm[11,13,14,17,18,20]and three-arm[7,12,15,19,21]techniques were reported.There were three relevant articles identified that studied quality of life in patients undergoing robotic lobectomy[21-23].

    ROBOTIC LOBECTOMY COST

    Cost definition and analysis

    Costs reported in these studies were based on the index hospitalization.There was significant heterogeneity in the definition of cost, how it was analyzed, and the detail provided of these costs.Studies reported total

    costs, direct costs, and/or indirect costs.Details on operating room (OR) charges and costs were provided by some studies.Professional fees were included in some studies, but not all.The micro-costing method was used to assess costs in the studies by Kauret al.[11]and Gondéet al.[7]Relative cost, rather than absolute cost, was reported in the study by Park[12].

    Table 1.Summary of robotic lobectomy cost studies

    Total costs were reported as the sum of indirect and direct costs in the study by Nasiret al.[13].Direct cost was defined as the cost of any items used and services provided in the care of the patient during the hospitalization.This included all operating room disposable equipment and supplies; staplers; laboratory tests; imaging studies; pharmacy items and medications; and salaries and benefits of personnel who delivered care to the patient.Indirect cost was defined as overhead cost and amortization of capital equipment and supplies and maintenance.

    Robotic specific costs were defined and reported by many studies and included direct costs such as disposable instruments, drapes, and other supplies.Other robotic specific costs provided included amortized cost/capital depreciation and maintenance costs.Robot depreciation in the study by Novelliset al.[14]was estimated from capital cost of 2 million euros plus annual maintenance of 200,000 euros divided by the number of procedures per year (400 cases) over eight years.Deenet al.[15]calculated capital depreciation and service cost of 1200 USA dollars (USD) per case by considering four robots priced at two million USD each, performing 2403 procedures in a 22-month period.Gondéet al.[7]calculated capital depreciation by dividing the sum of the purchase price and maintenance cost by the number of surgical procedures per year multiplied by the depreciation period.In the study by Nelsonet al.[16], the depreciation was calculated over five years.Some studies included these costs in the total hospitalization cost, while others did not.In the study by Kauret al.[11], these costs were excluded since they were reported to be covered by philanthropic subsidies and assumed no extra cost to the public health system of Canada.In the population-based study by Swansonet al.[9], the cost that they reported incorporated the cost of the procedure to the hospital, but not the acquisition and annual maintenance cost of the robot.

    In the prospective study by Gondéet al.[7], total cost was defined by length of stay related costs (clinical expense, medical logistics, general logistics, and buildings) and costs independent of length of stay (direct charges including medical supplies and medico-technical expenses including capital depreciation).Part of the cost calculations in this study was based on the French National Cost Study database.In two population-based studies, Subramanianet al.[1]and Paulet al.[10]estimated costs by using total hospitalization charges and applying hospital-specific cost-to-charge ratios.It is unclear how cost was derived in the study by Glennet al.[8], another population-based study, which had the highest total cost (102,057 USD) reported of all studies.In the study by Novelliset al.[14], estimated cost was reported as percentage of regional health service reimbursement.This was derived from using actual costs as well as estimated costs.

    Cost comparison of robotic lobectomy to vats and open lobectomy

    Six of 16 studies compared the cost of robotic lobectomy to both VATS and open approaches [Table 2][1,12,14-17].Two studies found no significant difference in adjusted costs when comparing robotic approach to either VATS or open approach for the total hospital stay[16,17]; however, one of these studies noted that it may have been underpowered to detect a difference between groups[16].Both studies used propensity score adjustment by inverse probability of treatment weighting.The study by Kneuertzet al.[17]did not find a difference in OR costs when comparing robotic to VATS (USD 9912vs.USD 9491;P= 0.44); however, open approach had lower operating room costs than robotic (USD 8698vs.USD 9912;P< 0.01).They observed an inverse relationship between OR related costs and postoperative related costs.Deenet al.[15]found that the overall cost for robotic approach was significantly higher than VATS ($17,011vs.$13,829;P< 0.001), but did not find a significant difference when compared to open approach ($17,011vs.$15,036;P= 0.058).OR costs and time were both higher in the robotic group when compared to either VATS or open group, but there was no significant difference for length of stay.A population-based study by Subramanian et al.[1]found a significantly higher index hospital cost for robotic lobectomy when compared with VATS and open approaches (robotic $20,377, VATS $17,802, and open $17,200; P < 0.001).The study by Park[12]found that robotic-assisted lobectomy was less expensive than open approach.

    Table 2.Comparison by surgical approach (robotic, VATS, and open)

    Nine studies compared the cost of robotic lobectomy with VATS only [Table 3][7-11,18,20,21].All of these studies found a significantly higher total cost in the robotic group when compared to VATS.When provided, the intraoperative costs or charges were also significantly higher in the robotic group.

    Profit

    Two studies discussed costs in terms of profit, one from the USA and the other from Italy[13,14].Nasir et al.[13]evaluated patients undergoing robotic lobectomies and segmentectomies during 2010-2013 at a single institution in the US, performed by a single surgeon using only Medicare patients.The medianprofit margin per patient was $3497.This was based on a median Medicare reimbursement of $18,937 and total median expense of $15,440 per patient.Profit margin was defined by the amount of reimbursement subtracted by the total expenses (direct and indirect costs) of the patient encounter.

    Table 3.Comparison by surgical approach (robotic and VATS)

    In the study by Novellis et al.[14], robotic lobectomy and segmentectomy performed for early stage lung cancer had higher costs when compared with VATS and open approaches; however, the estimated cost was 82% of the regional health service reimbursement for robotic approach, still resulting in a profit for the institution.The other two approaches were also profitable with estimated costs of 68% and 69% of reimbursement for VATS and open approaches, respectively.

    QUALITY OF LIFE

    Lacroix et al.[22]presented a single-center, retrospective analysis of 61 consecutive patients who underwent robotic lobectomy during its introduction to their unit from December 2012 to August 2015.They defined the learning period as their first 22 lobectomies and assessed quality of life (QOL) using the 36-Item Short Form Survey (SF-36) at midterm follow-up for the remaining 39 patients in their study.The mean physical component scale (PCS) score was 64.3 ± 17.6 and the mean mental component scale (MCS) score was 62.6 ± 19.6.The SF-36 was previously used at their institution to assess QOL for chest wall resection surgery, resulting in a mean PCS score of 40 and MCS score of 44.They found an association between pain and PCS scores, where PCS scores were significantly lower in patients with moderate pain (51.6 ± 14.2) than those with mild (69.4 ± 17.7) or no pain (67.8 ± 16.1) (P= 0.05).They concluded that QOL was satisfactory in their early experience for robotic lobectomy and was related to the pain level.

    In the study by Worrellet al.[21], costs and quality of life outcomes were evaluated during the initiation of their robotic lobectomy program.They compared their first 25 robotic assisted lobectomies with 73 VATS lobectomies, which were performed from 2010 to 2012.The European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-30) was used to assess QOL with responses from 29 of the 98 patients, 9 robotic and 20 VATS, at a median follow-up of 65 months.This study found no significant difference between the robotic and VATS groups in their global health status and symptom scale median scores.

    In a retrospective study, Cerfolioet al.[23]reported a consecutive series of patients with clinically apparent resectable non-small cell lung cancer (NSCLC) from February 2010 to April 2011 who underwent attempted completely portal robot lobectomy using the four-arm technique.This group was compared against propensity-matched controls who underwent nerve- and rib-sparing thoracotomy.The study was performed by a single surgeon at a single institution.Quality of life information was obtained at two time points, three weeks and four months after surgery, and was measured by the Short Form Health Survey (SF-12) with supplemental questions about pain control.The robotic lobectomy group had a significantly higher average mental quality of life (MCS) score at three weeks when compared with the thoracotomy controls (53.5vs.40.3;P< 0.001).A trend for higher physical quality of life (PCS) score at three weeks was observed with the robotic group, although it was not of statistical significance (40.3vs.43.1;P= 0.07).There was no significant difference observed for mental or physical quality of life at four months.The authors in this study noted that there may have been bias introduced in the surveys since the patients were informed that the robotic approach was a new and “l(fā)ess invasive” technique.

    DISCUSSION

    The hospital cost of robotic lobectomy during initiation of a robotic lobectomy program and/or early experiences at an institution has consistently been shown to be higher when compared to VATS lobectomy[11,18,20,21].There were many factors observed to affect total hospital cost, one of which was intraoperative cost.Studies that disclosed OR time during early experiences reported a significantly longer time for robotic lobectomies when compared to VATS [Table 3][11,18,20,21].Two of these studies observed a decrease in operating time with more experience, which translated into a difference in intraoperative cost[11,20].Kauret al.[11]found that, based on their micro-costing analysis, anatomic resections using the robotic approach cost more than VATS by $3116 per case.They considered significantly higher intraoperative times to be a main contributor to this difference, and reported that OR time using the robotic platform decreased over time.There was a mean difference of 71 min (P= 0.004) when comparing the first 20 robotic resections with the remaining 22 robotic resections, which resulted in an intraoperative cost difference of $883.38, reducing the total hospital cost.In their study, Spillaneet al.[20]attributed higher associated hospital charges for robotic-assisted lobectomies to increased cost of OR time.They also found a trend in a decrease in intraoperative duration with the robotic approach over time.In their study, Baoet al.[18]noted that longer operative time for the robotic group may be due to the limited robotic experience of the surgeon.

    This review also includes studies performed at centers with established robotic programs with high robotic surgical case volume.Case volume and surgeon experience may influence hospital costs.The amortized cost of robotic equipment is directly dependent on the number of cases performed, with higher volume resulting in lower costs.The two studies that unexpectedly demonstrated no significant difference in adjusted cost of robotic lobectomy compared to VATS were performed at high-volume surgical centers experienced in robotic surgery.These studies also found no significant difference in cost when comparing robotic to open lobectomy.Both Si and Xi systems were used and both reported on a more recent study period with patients evaluated into the year 2017.

    There are also non-operating room costs to take into consideration.Postoperative complications have been shown to increase costs[16,24].In Nelson's[16]study, they reported an association between pulmonary and cardiovascular complications with increase in mean costs for all approaches.While the majority of studies in this review did not find a significant difference in overall postoperative major or minor complications between robotic and VATS or open groups[7,8,11,14-19,21], this is a potential area for cost reduction.Kneuertzet al.[24]performed a retrospective review of patients at our institution who underwent robotic-assisted lobectomy for NSCLC and evaluated postoperative outcomes on cost.Postoperative complications and prolonged hospital stay added considerable hospital expenses, which was the largest variability in total cost in the study.

    The studies in this review that reported a difference in postoperative complications between groups were multi-institutional database studies[1,9].Swansonet al.[9]reported that patients undergoing lobectomy via robotic approach from 2009 to 2011 were 4.24 times more likely to have a minor event than those undergoing VATS.In contrast, the study by Subramanianet al.[1]found that, from 2009 to 2014, robotic lobectomy compared with VATS was associated with decreased adjusted risk of any minor postoperative complication, and, when compared with the open approach, had a decreased risk of any major or minor postoperative complication.Glennet al.[8]found no significant difference in overall morbidity between the robotic group and VATS group from 2010 to 2013; however, they observed that, in the earlier period of the study (2010-2011), morbidity was significantly higher in the robotic group when compared with VATS (robotic 42.9%vs.VATS 36.3%,P= 0.004).From 2012 to 2013, there was no longer a significant difference.Findings in these studies suggest, but do not confirm, that postoperative complications may be higher in earlier experiences of robotic lobectomy.

    Based on the literature comparing all three approaches at single institutions, the cost of robotic lobectomy appears to be comparable if not less costly than open lobectomy and/or profitable.While OR time was significantly longer in the robotic group in these studies, length of stay was shorter or similar.The reduction in length of stay was noted by some authors to account for their findings.From the three studies that evaluated quality of life in their early experience, it appears that the robotic approach has acceptable results, although the number of studies and patients evaluated are limited[21-23].

    Many studies in our review compared robotic approach to VATS only, with results consistently demonstrating higher costs for robotic lobectomy.Interestingly, no study was identified during our literature search that compared costs for robotic approach to thoracotomy only even when the data suggest that the continued decline in thoracotomy for lobectomies appears mainly a result from increased adoption of the robotic platform not from increased use of VATS[1,2].While the majority of studies show that robotic lobectomy has higher hospital costs than VATS, the significance of this finding is unclear.The difference in index hospital cost is of statistical significance, but its overall impact on patient outcomes and health economics has not been elucidated and the value of using the robotic platform has not been defined.Further studies on patient outcomes such as quality of life, recovery time, and morbidity, as well as surgeon factors, are needed.

    Study limitations

    There are limitations of this study.Due to the heterogeneity of how costs were defined and analyzed, a quantitative analysis is not feasible in this study and direct comparisons between studies could not be performed.There appears to be an overall underappreciation in the surgical literature of the differences among cost, charges, and recovery of services, which rendered comparison incredibly difficult.Additionally, there is little appreciation for the running costs that go into caring for these patients and are often assumed into operational overhead.This review was also based on observational studies, with all but one study utilizing retrospective analysis.In addition, the majority of studies reported using the Si, which is an older generation.Only two of 16 studies reviewed noted using the Xi, which was Food and Drug Administration approved and introduced to the USA in 2014.Another limitation is the limited number of studies regarding quality of life available for review.More studies on patient reported outcomes for those undergoing robotic lobectomies are needed to better understand its impact on quality of life.Finally, while we evaluated financial costs to the hospital and quality of life of patients undergoing robotic lobectomy, we did not comprehensively assess the value of the robotic platform.There are more important factors to consider beyond index hospitalization costs and PRO.

    CONCLUSION

    Developing a robotic lobectomy program may be associated with relatively higher index hospital costs when compared to VATS approach.With increased experience and volume of robotic cases, this difference may no longer be of significance, but additional defining of costs versus charges is needed as a surgical society.As an overall review, the cost of robotic lobectomy is comparable if not less costly than open lobectomy based on single institution studies and may be profitable for the hospital, if we can better understand the operational costs needed to care for these patients.Quality of life appears to be acceptable in the early experience of robotic lobectomy.

    DECLARATIONS

    Authors' contributions

    Manuscript preparation: Nishimura JM

    Editorial of manuscript: Nishimura JM, Goodwin M, Kneuertz P, Moffatt-Bruce S, Merritt RE, D'Souza DM

    Availability of data and materials

    Not applicable.

    Financial support and sponsorship

    None.

    Conflicts of interest

    Dr.Desmond D'Souza is a proctor for Intuitive Surgical Inc.Dr.Robert Merritt is a speaker for Intuitive Surgical Inc.All other authors declare no conflicts of interest.

    Ethical approval and consent to participate

    Not applicable.

    Consent for publication

    Not applicable.

    Copyright

    ? The Author(s) 2020.

    精华霜和精华液先用哪个| 亚洲欧洲日产国产| 精品欧美国产一区二区三| 韩国高清视频一区二区三区| 赤兔流量卡办理| 搞女人的毛片| 亚洲精品日韩在线中文字幕| 午夜激情久久久久久久| 国产精品熟女久久久久浪| 免费黄网站久久成人精品| av在线亚洲专区| 永久网站在线| 欧美精品国产亚洲| av卡一久久| 亚洲精品中文字幕在线视频 | 美女被艹到高潮喷水动态| 看十八女毛片水多多多| 久久精品久久久久久噜噜老黄| 乱人视频在线观看| 男插女下体视频免费在线播放| 特大巨黑吊av在线直播| 又黄又爽又刺激的免费视频.| 成年女人在线观看亚洲视频 | 免费观看精品视频网站| 欧美97在线视频| 人人妻人人看人人澡| 男女那种视频在线观看| 亚洲欧美日韩东京热| 亚洲成色77777| 午夜福利网站1000一区二区三区| 日本熟妇午夜| 肉色欧美久久久久久久蜜桃 | 亚洲精品中文字幕在线视频 | 美女xxoo啪啪120秒动态图| 久久久久久国产a免费观看| 免费av毛片视频| 精品熟女少妇av免费看| 人妻制服诱惑在线中文字幕| 蜜桃亚洲精品一区二区三区| 18禁裸乳无遮挡免费网站照片| 少妇的逼好多水| 午夜福利高清视频| 天堂中文最新版在线下载 | 亚洲精品影视一区二区三区av| 卡戴珊不雅视频在线播放| 亚洲国产精品成人综合色| 18禁在线无遮挡免费观看视频| 男女视频在线观看网站免费| 最后的刺客免费高清国语| 国产高清国产精品国产三级 | 直男gayav资源| 别揉我奶头 嗯啊视频| 精品久久久久久成人av| 亚洲国产精品成人久久小说| 噜噜噜噜噜久久久久久91| 色哟哟·www| 有码 亚洲区| 嫩草影院精品99| 综合色丁香网| 国产成年人精品一区二区| 91aial.com中文字幕在线观看| 边亲边吃奶的免费视频| 天天一区二区日本电影三级| 国产麻豆成人av免费视频| 国内精品宾馆在线| 女人十人毛片免费观看3o分钟| 在线观看美女被高潮喷水网站| av在线播放精品| 亚洲va在线va天堂va国产| 最后的刺客免费高清国语| 一本—道久久a久久精品蜜桃钙片 精品乱码久久久久久99久播 | 欧美日本视频| 极品教师在线视频| 国产欧美另类精品又又久久亚洲欧美| 亚洲av.av天堂| 免费大片18禁| 久久久久网色| 成人鲁丝片一二三区免费| 日本一二三区视频观看| 搡老妇女老女人老熟妇| 亚洲高清免费不卡视频| 最近2019中文字幕mv第一页| 婷婷色av中文字幕| 真实男女啪啪啪动态图| 人人妻人人看人人澡| 在线a可以看的网站| 国产永久视频网站| 欧美日韩在线观看h| 国产亚洲91精品色在线| 一级毛片电影观看| 性色avwww在线观看| 久久精品夜色国产| 一个人看视频在线观看www免费| 日本色播在线视频| 亚洲国产最新在线播放| 联通29元200g的流量卡| 国产三级在线视频| av在线播放精品| 内地一区二区视频在线| 91久久精品电影网| 青青草视频在线视频观看| 国产单亲对白刺激| 在线天堂最新版资源| 五月玫瑰六月丁香| 久久人人爽人人片av| 日韩电影二区| ponron亚洲| 精品久久久久久久久亚洲| 国产黄片视频在线免费观看| 内地一区二区视频在线| 亚洲成人av在线免费| 天天躁夜夜躁狠狠久久av| 亚洲精品乱久久久久久| 最近手机中文字幕大全| 精品久久久久久成人av| 午夜福利网站1000一区二区三区| 国产精品女同一区二区软件| 精品久久久久久成人av| 国内精品美女久久久久久| 国产亚洲午夜精品一区二区久久 | 国产成人aa在线观看| 久久这里有精品视频免费| 亚洲激情五月婷婷啪啪| 成人午夜高清在线视频| 日本一本二区三区精品| 国产亚洲5aaaaa淫片| 免费大片18禁| 老女人水多毛片| 国产一级毛片七仙女欲春2| 亚洲国产欧美人成| 国产精品蜜桃在线观看| 一级毛片黄色毛片免费观看视频| 激情 狠狠 欧美| 美女高潮的动态| 99久久九九国产精品国产免费| 久久久久精品久久久久真实原创| 久久久久精品性色| 岛国毛片在线播放| 日本猛色少妇xxxxx猛交久久| 国产黄色视频一区二区在线观看| 少妇熟女aⅴ在线视频| 国内揄拍国产精品人妻在线| 亚洲精品日本国产第一区| 久久这里有精品视频免费| 亚洲乱码一区二区免费版| 最近中文字幕高清免费大全6| 久久久久久久大尺度免费视频| 网址你懂的国产日韩在线| 日日撸夜夜添| 少妇熟女欧美另类| 精品国产露脸久久av麻豆 | 久久精品国产亚洲av天美| 亚洲成人av在线免费| 久久人人爽人人爽人人片va| 国产黄色视频一区二区在线观看| 免费看不卡的av| 亚洲自拍偷在线| 国精品久久久久久国模美| 久久精品国产鲁丝片午夜精品| 精品熟女少妇av免费看| av在线天堂中文字幕| 亚洲国产成人一精品久久久| 永久网站在线| 欧美zozozo另类| 亚洲国产精品国产精品| 国产女主播在线喷水免费视频网站 | 丰满乱子伦码专区| 蜜桃久久精品国产亚洲av| 国产熟女欧美一区二区| 少妇裸体淫交视频免费看高清| 国产黄色视频一区二区在线观看| 波野结衣二区三区在线| 国产亚洲最大av| 国产精品久久久久久久久免| 亚洲电影在线观看av| 亚洲欧洲日产国产| 精品久久久久久久久久久久久| 国产免费福利视频在线观看| 青青草视频在线视频观看| 尤物成人国产欧美一区二区三区| 婷婷色麻豆天堂久久| 91在线精品国自产拍蜜月| 老女人水多毛片| 亚洲精品视频女| 成人午夜高清在线视频| 80岁老熟妇乱子伦牲交| 久久精品夜夜夜夜夜久久蜜豆| 午夜免费激情av| 亚洲av中文字字幕乱码综合| 日本wwww免费看| 在线 av 中文字幕| 看免费成人av毛片| 国产黄a三级三级三级人| 美女高潮的动态| 在线a可以看的网站| 97在线视频观看| 色视频www国产| 黄色日韩在线| 一级毛片久久久久久久久女| 国产一区有黄有色的免费视频 | 亚洲四区av| 人人妻人人看人人澡| 亚洲欧美成人综合另类久久久| av女优亚洲男人天堂| 欧美+日韩+精品| 免费av毛片视频| 一级黄片播放器| 大香蕉久久网| 乱人视频在线观看| 国产淫语在线视频| 亚洲伊人久久精品综合| 色视频www国产| 在线天堂最新版资源| 欧美性猛交╳xxx乱大交人| 别揉我奶头 嗯啊视频| 日韩一本色道免费dvd| 久久97久久精品| 国产成人a区在线观看| 三级国产精品欧美在线观看| 性插视频无遮挡在线免费观看| 精品一区二区三卡| 婷婷六月久久综合丁香| 建设人人有责人人尽责人人享有的 | 精品久久久精品久久久| 99re6热这里在线精品视频| 高清日韩中文字幕在线| 91精品国产九色| 天堂中文最新版在线下载 | 午夜免费激情av| 亚洲性久久影院| 色吧在线观看| 亚洲国产成人一精品久久久| 久久99精品国语久久久| 在线 av 中文字幕| 色网站视频免费| 美女xxoo啪啪120秒动态图| 高清在线视频一区二区三区| 人人妻人人澡欧美一区二区| 成人性生交大片免费视频hd| 成人亚洲欧美一区二区av| 乱人视频在线观看| av专区在线播放| 日韩伦理黄色片| 日韩 亚洲 欧美在线| 国产精品.久久久| 国国产精品蜜臀av免费| 国产大屁股一区二区在线视频| 亚洲欧美精品专区久久| 51国产日韩欧美| 三级经典国产精品| 一级毛片久久久久久久久女| 赤兔流量卡办理| 久久99热这里只有精品18| 麻豆精品久久久久久蜜桃| 欧美区成人在线视频| 一级毛片久久久久久久久女| 波多野结衣巨乳人妻| 高清日韩中文字幕在线| 欧美高清性xxxxhd video| 婷婷色麻豆天堂久久| 男插女下体视频免费在线播放| 不卡视频在线观看欧美| 国产视频首页在线观看| 国产欧美日韩精品一区二区| 国产精品国产三级国产av玫瑰| 啦啦啦啦在线视频资源| freevideosex欧美| 水蜜桃什么品种好| 永久免费av网站大全| 好男人视频免费观看在线| 国产午夜精品论理片| 国产av不卡久久| 精品亚洲乱码少妇综合久久| 美女主播在线视频| 天堂俺去俺来也www色官网 | 99久久精品国产国产毛片| 国产一区二区三区综合在线观看 | 亚洲自偷自拍三级| 乱码一卡2卡4卡精品| 国产一区二区三区av在线| 久99久视频精品免费| 老司机影院毛片| 国产黄色小视频在线观看| 久久精品熟女亚洲av麻豆精品 | 极品教师在线视频| 亚洲自拍偷在线| 熟女人妻精品中文字幕| 永久网站在线| 亚洲精品国产av成人精品| 国产精品一区二区三区四区免费观看| 欧美性猛交╳xxx乱大交人| 精品一区二区三卡| xxx大片免费视频| av线在线观看网站| 国产不卡一卡二| 韩国av在线不卡| 1000部很黄的大片| 久久久久网色| 成人毛片60女人毛片免费| 国模一区二区三区四区视频| 国产精品.久久久| 欧美日韩视频高清一区二区三区二| 免费观看精品视频网站| 777米奇影视久久| 精品亚洲乱码少妇综合久久| 99久久精品热视频| 亚洲人成网站在线播| 街头女战士在线观看网站| 最近2019中文字幕mv第一页| 精品一区二区三区人妻视频| 春色校园在线视频观看| 亚洲电影在线观看av| 亚洲高清免费不卡视频| 女人久久www免费人成看片| 乱人视频在线观看| 久久亚洲国产成人精品v| 男女边吃奶边做爰视频| 大又大粗又爽又黄少妇毛片口| 日韩制服骚丝袜av| 久久精品国产鲁丝片午夜精品| 婷婷色综合大香蕉| 麻豆av噜噜一区二区三区| 男女边摸边吃奶| 精品一区二区三区视频在线| 一区二区三区高清视频在线| 成人性生交大片免费视频hd| 久久久久久九九精品二区国产| 亚洲精品国产av成人精品| 国产精品1区2区在线观看.| av在线播放精品| 欧美激情国产日韩精品一区| 18禁在线播放成人免费| 日韩电影二区| 久久精品国产自在天天线| 亚洲精品日本国产第一区| 久久99热6这里只有精品| 亚洲精品成人av观看孕妇| 看黄色毛片网站| av在线观看视频网站免费| 国产高清有码在线观看视频| 日韩欧美国产在线观看| 国产三级在线视频| 国产成人a∨麻豆精品| 国产伦精品一区二区三区四那| 26uuu在线亚洲综合色| 婷婷色综合www| 大又大粗又爽又黄少妇毛片口| 国产黄频视频在线观看| 一区二区三区四区激情视频| 国产色爽女视频免费观看| 一区二区三区高清视频在线| 午夜亚洲福利在线播放| 精品亚洲乱码少妇综合久久| 国内少妇人妻偷人精品xxx网站| 日本av手机在线免费观看| 午夜久久久久精精品| 久久久午夜欧美精品| 天天躁日日操中文字幕| 大又大粗又爽又黄少妇毛片口| 国产亚洲5aaaaa淫片| 国产精品日韩av在线免费观看| 麻豆乱淫一区二区| 色网站视频免费| 国产精品日韩av在线免费观看| 成年免费大片在线观看| 人人妻人人看人人澡| 国产一区二区三区av在线| 午夜免费激情av| 高清在线视频一区二区三区| 国产永久视频网站| 非洲黑人性xxxx精品又粗又长| 日韩av不卡免费在线播放| 中文乱码字字幕精品一区二区三区 | 少妇被粗大猛烈的视频| 成人鲁丝片一二三区免费| 国产av在哪里看| 久久人人爽人人片av| 亚洲精品乱码久久久久久按摩| 久久国内精品自在自线图片| 国产免费福利视频在线观看| 麻豆成人午夜福利视频| 日韩人妻高清精品专区| 免费在线观看成人毛片| 国产精品国产三级专区第一集| 久久精品夜色国产| av在线观看视频网站免费| 三级国产精品片| 日产精品乱码卡一卡2卡三| 久久精品国产亚洲网站| av在线观看视频网站免费| 一级黄片播放器| 神马国产精品三级电影在线观看| 免费黄色在线免费观看| 2022亚洲国产成人精品| 国产69精品久久久久777片| 久久99精品国语久久久| 国产精品蜜桃在线观看| www.色视频.com| 久久精品国产鲁丝片午夜精品| 免费av毛片视频| 丝袜喷水一区| 最近最新中文字幕免费大全7| videos熟女内射| 久久久久久久久久黄片| 午夜免费观看性视频| 有码 亚洲区| 少妇的逼水好多| 亚洲欧洲日产国产| 人妻一区二区av| 在线观看美女被高潮喷水网站| 一个人看视频在线观看www免费| 两个人视频免费观看高清| 国产白丝娇喘喷水9色精品| 一个人观看的视频www高清免费观看| 国产精品一区二区在线观看99 | 日韩成人伦理影院| 国产黄色小视频在线观看| 少妇高潮的动态图| 男插女下体视频免费在线播放| 身体一侧抽搐| 亚洲人与动物交配视频| 精品人妻视频免费看| 午夜精品国产一区二区电影 | 国产一区二区亚洲精品在线观看| 国产精品人妻久久久久久| 在线观看美女被高潮喷水网站| 看免费成人av毛片| 精品久久久精品久久久| 男的添女的下面高潮视频| 简卡轻食公司| 日产精品乱码卡一卡2卡三| 亚洲精品中文字幕在线视频 | 免费看av在线观看网站| 热99在线观看视频| 亚洲av成人精品一区久久| 久久久久久久久中文| 亚洲精品乱久久久久久| 欧美潮喷喷水| 青春草亚洲视频在线观看| 天天一区二区日本电影三级| 丰满少妇做爰视频| 91久久精品电影网| 亚洲成人一二三区av| 国产 一区精品| 欧美极品一区二区三区四区| 日韩欧美三级三区| 午夜精品一区二区三区免费看| 久久久久久久午夜电影| 久久久久免费精品人妻一区二区| 一个人观看的视频www高清免费观看| 人体艺术视频欧美日本| 日韩亚洲欧美综合| 国产三级在线视频| av线在线观看网站| 天堂√8在线中文| 80岁老熟妇乱子伦牲交| 免费观看性生交大片5| 亚洲成人av在线免费| 亚洲精品日本国产第一区| 男人舔奶头视频| 国产精品嫩草影院av在线观看| av天堂中文字幕网| 性色avwww在线观看| 人妻夜夜爽99麻豆av| 韩国av在线不卡| 欧美日韩精品成人综合77777| 蜜桃久久精品国产亚洲av| 久久国产乱子免费精品| 麻豆乱淫一区二区| 日本色播在线视频| 老师上课跳d突然被开到最大视频| 男人舔女人下体高潮全视频| 如何舔出高潮| 精品一区二区免费观看| 日韩一区二区视频免费看| 免费大片18禁| av福利片在线观看| 成人av在线播放网站| 2022亚洲国产成人精品| 九九爱精品视频在线观看| 亚洲自偷自拍三级| 欧美日本视频| 嫩草影院入口| 三级国产精品欧美在线观看| 成年免费大片在线观看| 色综合亚洲欧美另类图片| 久久久久久久亚洲中文字幕| 久久久精品欧美日韩精品| 国产伦一二天堂av在线观看| av卡一久久| av在线蜜桃| 在线免费观看不下载黄p国产| 亚洲成人中文字幕在线播放| 日韩欧美国产在线观看| 淫秽高清视频在线观看| h日本视频在线播放| 久久久色成人| 街头女战士在线观看网站| 久久久久久久久久久丰满| 亚洲内射少妇av| 欧美激情国产日韩精品一区| 国语对白做爰xxxⅹ性视频网站| ponron亚洲| 晚上一个人看的免费电影| 亚洲综合色惰| 国产成人午夜福利电影在线观看| 91精品伊人久久大香线蕉| 日本-黄色视频高清免费观看| 国产美女午夜福利| 美女主播在线视频| 国产免费又黄又爽又色| 午夜亚洲福利在线播放| 精品熟女少妇av免费看| 麻豆av噜噜一区二区三区| 亚洲国产精品专区欧美| 成人欧美大片| 日本爱情动作片www.在线观看| 全区人妻精品视频| 99热6这里只有精品| eeuss影院久久| 精品久久久噜噜| 在线观看美女被高潮喷水网站| 精品国产露脸久久av麻豆 | 天堂中文最新版在线下载 | 99久久人妻综合| 精品久久国产蜜桃| 色综合色国产| 国产片特级美女逼逼视频| 国产 一区精品| 亚洲av成人精品一区久久| 偷拍熟女少妇极品色| 夫妻性生交免费视频一级片| 乱系列少妇在线播放| 26uuu在线亚洲综合色| 国产淫语在线视频| 亚洲aⅴ乱码一区二区在线播放| 成年女人看的毛片在线观看| 又爽又黄无遮挡网站| 亚州av有码| 国产精品99久久久久久久久| 男插女下体视频免费在线播放| av在线观看视频网站免费| 日韩欧美国产在线观看| 国产精品精品国产色婷婷| 99久久九九国产精品国产免费| 男人爽女人下面视频在线观看| 国产精品无大码| 国产成人精品一,二区| 国产黄色小视频在线观看| 国产成人精品久久久久久| 美女高潮的动态| 亚洲av免费在线观看| 99re6热这里在线精品视频| 亚洲av免费高清在线观看| 亚洲精品日韩av片在线观看| 免费少妇av软件| 欧美日韩视频高清一区二区三区二| 欧美日韩一区二区视频在线观看视频在线 | 成人无遮挡网站| 日日啪夜夜撸| 日日啪夜夜爽| 狂野欧美激情性xxxx在线观看| h日本视频在线播放| 非洲黑人性xxxx精品又粗又长| 国产精品久久久久久精品电影| 日韩在线高清观看一区二区三区| 久久久久九九精品影院| 亚洲自拍偷在线| 成人综合一区亚洲| 国产免费视频播放在线视频 | 精品99又大又爽又粗少妇毛片| 国产精品三级大全| 国产白丝娇喘喷水9色精品| 97精品久久久久久久久久精品| 搡女人真爽免费视频火全软件| 久久这里有精品视频免费| 大片免费播放器 马上看| 日韩一本色道免费dvd| 日日啪夜夜爽| 综合色丁香网| 国产精品日韩av在线免费观看| 熟妇人妻久久中文字幕3abv| 99久久精品国产国产毛片| 哪个播放器可以免费观看大片| 欧美潮喷喷水| 一区二区三区免费毛片| 亚洲欧美精品专区久久| 中文字幕久久专区| 亚洲欧美日韩卡通动漫| 亚洲精品亚洲一区二区| 久久精品国产鲁丝片午夜精品| 99九九线精品视频在线观看视频| 亚洲欧美精品自产自拍| 国产91av在线免费观看| 噜噜噜噜噜久久久久久91| 国产精品久久久久久久电影| 如何舔出高潮| av一本久久久久| 免费观看在线日韩| 狠狠精品人妻久久久久久综合| 色哟哟·www| 欧美区成人在线视频| 亚洲精品456在线播放app| 一级片'在线观看视频| 国产精品一区二区在线观看99 | 中文天堂在线官网| 亚洲国产精品国产精品| 视频中文字幕在线观看| 国产爱豆传媒在线观看| 日韩欧美国产在线观看| 久久精品久久精品一区二区三区| 边亲边吃奶的免费视频| 精品人妻一区二区三区麻豆| 日韩成人av中文字幕在线观看| 久久热精品热|