{"title":"机器人与腹腔镜胃癌全胃切除术技术错误和危险区的识别与分类：单中心前瞻性随机对照研究》。","authors":"Zhuoyu Jia, Shougen Cao, Daosheng Wang, Changshi Tang, Xiaojie Tan, Shanglong Liu, Xiaodong Liu, Zequn Li, Yulong Tian, Zhaojian Niu, Benjie Tang, Yanbing Zhou","doi":"10.1097/SLA.0000000000006585","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard-zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes.</p><p><strong>Objective: </strong>Identify and process risk areas in robot-assisted total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to get the best patient results.</p><p><strong>Design: </strong>Patients undergoing RTG and LTG were recruited and randomized into the study. Six consultant/attending surgeons participated in this study and all surgical procedures were recorded. The unedited surgical video-recordings were handed over to third-party experts for granular analysis of the procedures using objective clinical human reliability analysis (OC-HRA) for the quality of intraoperative performance, technical errors, intraoperative complications.</p><p><strong>Setting: </strong>This study is a single center prospective randomized controlled trial.</p><p><strong>Participants: </strong>82 patients were recruited and participated in this study with 40 cases undergoing RTG and 42 cases for LTG.</p><p><strong>Interventions: </strong>RTG vs LTG.</p><p><strong>Main outcomes and measures: </strong>Determine whether RTG or LTG can provide the better intraoperative technical performance and identify the most hazardous zone (area) during total gastrectomy (TG).</p><p><strong>Results: </strong>The technical errors enacted and identified in the RTG and the LTG were (46.11±5.63 VS 58.79±8.45, P＜0.001) respectively. The highest number of technical errors was identified during the dissection of the supra-pancreatic lymph nodes (Task Zones3, TZ3), including No.5, 7, 8a, 9, 11p, and 12a to complete the nodal clearance around the celiac artery and its trifurcation (7.29±1.88 VS 9.43±2.24, P <0.001) in both RTG and LTG. The number of lymph nodes harvested with RTG was higher than LTG (35.36±7.51 VS 30.54±6.95, P=0.016), especially in the upper margin of the pancreas (13.32±4.17 VS 9.36±3.81, P＜0.001). The total cost of hospitalization in the RTG group cost 3% more than LTG group ($15953.41±3533.91 VS $12198.26±2761.27, P＜0.001).</p><p><strong>Conclusions: </strong>This study offers compelling OC-HRA evidence demonstrating that RTG facilitates significantly superior technical performance compared to LTG. Whether examining short-term clinical outcomes or intraoperative operations, the robotic surgery system consistently outperforms laparoscopic surgery. Lymph node dissection in the supra-pancreatic region emerged as a major hazard zone in both procedures.</p><p><strong>Trial registration: </strong>chictr.org.cn: ChiCTR2000039193.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Identification and Categorization of Technical Errors and Hazard-zones of Robotic versus Laparoscopic total Gastrectomy for Gastric Cancer: A Single Center Prospective Randomized Controlled Study.\",\"authors\":\"Zhuoyu Jia, Shougen Cao, Daosheng Wang, Changshi Tang, Xiaojie Tan, Shanglong Liu, Xiaodong Liu, Zequn Li, Yulong Tian, Zhaojian Niu, Benjie Tang, Yanbing Zhou\",\"doi\":\"10.1097/SLA.0000000000006585\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard-zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes.</p><p><strong>Objective: </strong>Identify and process risk areas in robot-assisted total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to get the best patient results.</p><p><strong>Design: </strong>Patients undergoing RTG and LTG were recruited and randomized into the study. Six consultant/attending surgeons participated in this study and all surgical procedures were recorded. The unedited surgical video-recordings were handed over to third-party experts for granular analysis of the procedures using objective clinical human reliability analysis (OC-HRA) for the quality of intraoperative performance, technical errors, intraoperative complications.</p><p><strong>Setting: </strong>This study is a single center prospective randomized controlled trial.</p><p><strong>Participants: </strong>82 patients were recruited and participated in this study with 40 cases undergoing RTG and 42 cases for LTG.</p><p><strong>Interventions: </strong>RTG vs LTG.</p><p><strong>Main outcomes and measures: </strong>Determine whether RTG or LTG can provide the better intraoperative technical performance and identify the most hazardous zone (area) during total gastrectomy (TG).</p><p><strong>Results: </strong>The technical errors enacted and identified in the RTG and the LTG were (46.11±5.63 VS 58.79±8.45, P＜0.001) respectively. 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Lymph node dissection in the supra-pancreatic region emerged as a major hazard zone in both procedures.</p><p><strong>Trial registration: </strong>chictr.org.cn: ChiCTR2000039193.</p>\",\"PeriodicalId\":8017,\"journal\":{\"name\":\"Annals of surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2024-11-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SLA.0000000000006585\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006585","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
重要性：目前的研究旨在详细分析机器人和腹腔镜外科医生在进行全胃切除术时的术中手术表现、短期疗效、技术错误的识别和分类以及危险区。需要进行前瞻性研究，以确定机器人手术的技术优势是否能转化为患者的预后：识别并处理机器人辅助全胃切除术（RTG）和腹腔镜全胃切除术（LTG）中的风险区域，以获得最佳的患者效果：招募接受机器人辅助全胃切除术（RTG）和腹腔镜全胃切除术（LTG）的患者并将其随机纳入研究。六名顾问/主治外科医生参与了这项研究，并记录了所有手术过程。未经编辑的手术录像交由第三方专家使用客观临床人类可靠性分析（OC-HRA）对术中表现质量、技术错误、术中并发症等进行细化分析：本研究为单中心前瞻性随机对照试验。参与者：共招募 82 名患者参与本研究，其中 40 例接受 RTG，42 例接受 LTG：主要结果和测量：主要结果和测量指标：确定RTG或LTG是否能提供更好的术中技术性能，并确定全胃切除术（TG）中最危险的区域：结果：RTG和LTG术中发生和发现的技术错误分别为（46.11±5.63 VS 58.79±8.45，P＜0.001）。在解剖胰上淋巴结（任务区3，TZ3），包括5号、7号、8a号、9号、11p号和12a号以完成腹腔动脉及其三叉周围的结节清扫时发现的技术错误最多（7.29±1.88 VS 9.43±2.24，P 结论：本研究提供了令人信服的 OC-HRA 证据，证明 RTG 的技术性能明显优于 LTG。无论是短期临床效果还是术中操作，机器人手术系统始终优于腹腔镜手术。胰上淋巴结清扫是两种手术的主要危险区：ChiCTR2000039193。
Identification and Categorization of Technical Errors and Hazard-zones of Robotic versus Laparoscopic total Gastrectomy for Gastric Cancer: A Single Center Prospective Randomized Controlled Study.
Importance: The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard-zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes.
Objective: Identify and process risk areas in robot-assisted total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to get the best patient results.
Design: Patients undergoing RTG and LTG were recruited and randomized into the study. Six consultant/attending surgeons participated in this study and all surgical procedures were recorded. The unedited surgical video-recordings were handed over to third-party experts for granular analysis of the procedures using objective clinical human reliability analysis (OC-HRA) for the quality of intraoperative performance, technical errors, intraoperative complications.
Setting: This study is a single center prospective randomized controlled trial.
Participants: 82 patients were recruited and participated in this study with 40 cases undergoing RTG and 42 cases for LTG.
Interventions: RTG vs LTG.
Main outcomes and measures: Determine whether RTG or LTG can provide the better intraoperative technical performance and identify the most hazardous zone (area) during total gastrectomy (TG).
Results: The technical errors enacted and identified in the RTG and the LTG were (46.11±5.63 VS 58.79±8.45, P＜0.001) respectively. The highest number of technical errors was identified during the dissection of the supra-pancreatic lymph nodes (Task Zones3, TZ3), including No.5, 7, 8a, 9, 11p, and 12a to complete the nodal clearance around the celiac artery and its trifurcation (7.29±1.88 VS 9.43±2.24, P <0.001) in both RTG and LTG. The number of lymph nodes harvested with RTG was higher than LTG (35.36±7.51 VS 30.54±6.95, P=0.016), especially in the upper margin of the pancreas (13.32±4.17 VS 9.36±3.81, P＜0.001). The total cost of hospitalization in the RTG group cost 3% more than LTG group ($15953.41±3533.91 VS $12198.26±2761.27, P＜0.001).
Conclusions: This study offers compelling OC-HRA evidence demonstrating that RTG facilitates significantly superior technical performance compared to LTG. Whether examining short-term clinical outcomes or intraoperative operations, the robotic surgery system consistently outperforms laparoscopic surgery. Lymph node dissection in the supra-pancreatic region emerged as a major hazard zone in both procedures.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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