Marecik Slawomir J, Chaudhry Vivek, Jan Azam, Pearl Russell K, Park John J, Prasad Leela M
Advocate Lutheran General Hospital, Department of Surgery, 1775 W. Dempster St., 8 South, Park Ridge, IL 60068, USA
Am J Surg. 2007 Mar;193(3):349-55; discussion 355. doi: 10.1016/j.amjsurg.2006.09.018.
Robotic surgery offers all the advantages of laparoscopy with additional increased accuracy. The use of robotic surgery has increased in the past 5 years. It has proven particularly useful in complex surgical procedures such as intracorporeal intestinal anastomosis. As the prevalence of robotic surgery increases, so will the need for residents to be able to perform surgery using the robotic system. Our goal was to compare hand-sewn, laparoscopic, and robotic suturing techniques performed by midlevel residents using a porcine intestinal model.
Fifteen residents unfamiliar with the robotic suturing technique participated in performing an initial hand-sewn suture line and then were randomized with cross-over to laparoscopic or robotic suturing. Completion time, leak pressure, number of sutures per cm, and difficulty level were assessed.
The mean leak pressure for hand-sewn, laparoscopic, and robotic suturing was 9.5, 3.2, and 11.4 mm Hg, respectively. The laparoscopic group had 6 and the robotic group had 1 suture line that was inadequate for testing. Suture breakage was common in the robotic group. The anastomosis was considered hard by 92% in the laparoscopic group versus 17% in the robotic group. The time it took to complete 1 cm of anastomosis was .9, 8.7, and 8.3 minutes for hand-sewn, laparoscopic, and robotic suturing, respectively.
The robotic suture line performed by midlevel residents was superior to laparoscopy, although the time for anastomosis was equivalent.
机器人手术具备腹腔镜手术的所有优势，且准确性更高。在过去5年中，机器人手术的应用有所增加。事实证明，它在诸如体内肠道吻合等复杂手术中特别有用。随着机器人手术的普及，住院医师使用机器人系统进行手术的需求也会增加。我们的目标是比较中级住院医师使用猪肠模型进行手工缝合、腹腔镜缝合和机器人缝合技术的效果。
15名不熟悉机器人缝合技术的住院医师先进行初始手工缝合线操作，然后交叉随机分配至腹腔镜缝合或机器人缝合组。评估完成时间、漏液压力、每厘米缝线数量和难度级别。
手工缝合、腹腔镜缝合和机器人缝合的平均漏液压力分别为9.5、3.2和11.4毫米汞柱。腹腔镜组有6条缝合线，机器人组有1条缝合线不符合测试要求。机器人组中缝线断裂很常见。腹腔镜组92%的人认为吻合困难，而机器人组这一比例为17%。手工缝合、腹腔镜缝合和机器人缝合完成1厘米吻合所需时间分别为0.9、8.7和8.3分钟。
中级住院医师进行的机器人缝合线效果优于腹腔镜缝合，尽管吻合时间相当。
