Borden Lester S, Kozlowski Paul M, Porter Christopher R, Corman John M
Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington, USA.
Can J Urol. 2007 Apr;14(2):3499-501.
Robotic-assisted laparoscopic radical prostatectomy (RLRP) is playing an increasing role in the surgical management of prostate cancer. The benefits of minimally invasive surgery, enhanced surgeon familiarity with the instrumentation, and increased patient demand has led to the popularity of this surgical technique. There are, however, shortcomings specifically associated with this technology. Notably, instrumentation failure associated with robotic procedures represents a new and unique problem in urological surgery. We examine the rate of mechanical failure of the da Vinci robotic system and its impact on our prostate cancer program.
We reviewed our prospective, institutional review board-approved database of the first 350 RLRP procedures that were scheduled for surgery at our institution. We identified all cases in which mechanical failure of the da Vinci robotic system resulted in surgery being cancelled, postponed, or converted to a conventional laparoscopic or an open radical prostatectomy.
Nine of the 350 (2.6%) scheduled RLRPs were unable to be completed robotically secondary to device malfunction. Six of the malfunctions were detected prior to anesthesia induction and surgery was rescheduled. Three other malfunctions occurred intraoperatively and were converted either to a conventional laparoscopic (1 case) or an open surgical approach (2 cases). The etiology of the malfunctions included the following: set-up joint malfunction (2), arm malfunction (2), power error (1), monocular monitor loss (1), camera malfunction (1), metal fatigue/ break of surgeon's console hand piece (1) and software incompatibility (1).
Although uncommon, malfunction of the da Vinci robotic system does occur and may lead to psychological, financial, and logistical burdens for patients, physicians, and hospitals. Patients should be carefully counseled preoperatively regarding the possibility of robotic mechanical failure.
机器人辅助腹腔镜根治性前列腺切除术（RLRP）在前列腺癌的手术治疗中发挥着越来越重要的作用。微创手术的优势、外科医生对器械的熟悉程度提高以及患者需求的增加，使得这种手术技术广受欢迎。然而，这项技术存在一些特定的缺点。值得注意的是，与机器人手术相关的器械故障是泌尿外科手术中一个新的独特问题。我们研究了达芬奇机器人系统的机械故障率及其对我们前列腺癌治疗项目的影响。
我们回顾了本院前瞻性、经机构审查委员会批准的前350例计划进行手术的RLRP数据库。我们确定了所有因达芬奇机器人系统机械故障导致手术取消、推迟或改为传统腹腔镜手术或开放性根治性前列腺切除术的病例。
350例计划进行的RLRP中有9例（2.6%）因设备故障无法通过机器人完成手术。其中6例故障在麻醉诱导前被检测到，手术重新安排。另外3例故障发生在术中，改为传统腹腔镜手术（1例）或开放手术（2例）。故障的病因包括：设置关节故障（2例）、手臂故障（2例）、电源错误（1例）、单目监视器故障（1例）、摄像头故障（1例）、外科医生控制台手持件金属疲劳/断裂（1例）和软件不兼容（1例）。
尽管不常见，但达芬奇机器人系统确实会发生故障，可能给患者、医生和医院带来心理、经济和后勤负担。术前应仔细向患者告知机器人机械故障的可能性。
