Kornprat Peter, Werkgartner Georg, Cerwenka Herwig, Bacher Heinz, El-Shabrawi Azab, Rehak Peter, Mischinger Hans Jörg
Division of General Surgery, Department of Surgery, University Medical Center, Auenbruggerplatz 29, Graz 8036, Austria.
Langenbecks Arch Surg. 2006 Jun;391(3):216-21. doi: 10.1007/s00423-006-0046-4. Epub 2006 May 6.
Laparoscopic surgery has become the treatment of choice for cholecystectomy. Many studies showed that while this approach benefits the patient, the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence. Robots have the potential to overcome these problems. To evaluate the efficiency and feasibility of robotically assisted surgery (RAC), we designed a prospective study to compare it with standard laparoscopic cholecystectomy (SLC).
Between 2001 and 2003, 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system. The feasibility, safety, and possible advantages were evaluated. To assess the efficacy, the total time in the operating room was divided into preoperative, operative, and postoperative time frames.
For RAC in comparison with SLC, the preoperative phase including equipment setup was significantly longer. In the intraoperative phase, the cut-closure time and camera and trocar insertion times were significantly longer. It is interesting to note that the net dissection time for the cystic artery, duct, and the gall bladder was not different from SLC.
The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity. There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore, presents no benefit in using the robot in laparoscopic cholecystectomy.
腹腔镜手术已成为胆囊切除术的首选治疗方法。许多研究表明，虽然这种方法对患者有益，但外科医生面临着诸如人体工程学状况不佳以及由此导致的运动自由度受限等明显缺点。机器人有潜力克服这些问题。为了评估机器人辅助手术（RAC）的效率和可行性，我们设计了一项前瞻性研究，将其与标准腹腔镜胆囊切除术（SLC）进行比较。
在2001年至2003年期间，26例患者接受了SLC，20例患者使用ZEUS系统接受了RAC。对其可行性、安全性和可能的优势进行了评估。为了评估疗效，将手术室的总时间分为术前、术中和术后时间段。
与SLC相比，RAC的术前阶段（包括设备设置）明显更长。在术中阶段，切割闭合时间以及摄像头和套管针插入时间明显更长。值得注意的是，胆囊动脉、胆管和胆囊的净解剖时间与SLC并无差异。
该研究证明了机器人辅助胆囊切除术的可行性，且无特定系统的发病率。由于设备的设置和拆卸，机器人手术的几个阶段存在时间损失，因此，在腹腔镜胆囊切除术中使用机器人并无益处。
