Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series.

IF 1.6 Q4 ONCOLOGY
International Journal of Surgical Oncology Pub Date : 2015-01-01 Epub Date: 2015-02-15 DOI:10.1155/2015/814315
Natalia Povolotskaya, Robert Woolas, Dirk Brinkmann
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引用次数: 9

Abstract

Background: Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data.

Method: Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team.

Results: A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100 mL in both groups.

Conclusion: Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach.

妇科肿瘤机器人手术方案的实施及与先前腹腔镜系列的比较。
背景:妇科肿瘤机器人手术是一个快速发展的领域,因为它比传统的腹腔镜手术具有许多技术优势。在我们的学习曲线期间,对机器人手术的结果进行了审计,并与最近建立的腹腔镜手术数据进行了比较。方法:在获得达芬奇手术系统(Intuitive Surgical, Inc., Sunnyvale, California, USA)后,我们前瞻性地分析了前六个月内由一位经过适当培训和指导的经验丰富的妇科医生进行的所有病例。收集年龄、BMI、病理、手术类型、出血量、发病率、返回手术室、住院时间和再入院率的数据,并与前6个月由同一团队进行的连续系列腹腔镜手术进行比较。结果:对两个连续系列进行了比较。平均年龄略有不同,机器人组为55岁,而腹腔镜组为69岁,但肥胖是两组的一个特征,平均BMI分别为29.3和28.06。差异无统计学意义(P = 0.54)。进行了三个亚组最小通道手术:全子宫切除术和双侧输卵管卵巢切除术(TH + BSO),全子宫切除术和双侧输卵管卵巢切除术加双侧盆腔淋巴结切除术(TH + BSO + BPLND),根治性子宫切除术加双侧盆腔淋巴结切除术(RH + BPLND)。机器人组进行TH + BSO手术的平均时间更长,为151.2分钟,而腹腔镜组为126.3分钟。TH + BSO + BPLND手术时间机器人组为178.3 min,腹腔镜组为176.5 min。RH + BPLND手术时间相似,机械臂263.6 min,腹腔镜臂264.0 min。然而,在最初的分析中,数字很小,特别是在最后两个亚组中,因此不允许进行统计分析。需要干预的并发症发生率(Clavien-Dindo分类等级2/3)在机械臂中(22.7%)高于腹腔镜入路(4.5%)。机器人组的再入院率(18.2%)高于腹腔镜组(4.5%)。机器人组复诊率为18.2%,腹腔镜组为4.5%。简单机器人手术组的住院时间似乎更短,为1.3天,而简单腹腔镜组为2.5天。两组患者均未转为开腹手术。两组患者的估计失血量均小于100 mL。结论:机器人手术在失血量方面与腹腔镜手术相当;然而,在无并发症的病例中,腹腔镜臂的住院时间似乎更长。在复杂的情况下,手术机器人的时间相当于腹腔镜,但在不需要淋巴结清扫的情况下可能更长。机器人手术团队的学习曲线可能与较高的发病率有关。对外科医生的益处需要进一步的研究来阐明这种多用途的新颖手术入路的全貌。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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