Lowe M Patrick, Johnson Peter R, Kamelle Scott A, Kumar Saurabh, Chamberlain Donald H, Tillmanns Todd D
From the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Northwestern University, Chicago, Illinois; Gynecologic Oncology, University of Tennessee, Chattanooga, Chattanooga, Tennessee; Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Aurora Health Center, Milwaukee, Wisconsin; and Department of Obstetrics and Gynecology, University of Tennessee Health Science Center and West Clinic, Memphis, Tennessee.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):236-243. doi: 10.1097/AOG.0b013e3181af2a74.
To report perioperative outcomes and learning curve characteristics from a multiinstitutional experience with robotic-assisted surgical staging for endometrial cancer.
A multiinstitutional robotic surgical consortium was created to evaluate the usefulness of robotics for gynecologic oncology surgery. An analysis of a multiinstitutional database of all patients who underwent robotic surgery for endometrial carcinoma between April 2003 and January 2009 was performed. Records were reviewed for demographic data and perioperative outcomes. Individual surgeon outcomes were analyzed as well in an attempt to evaluate characteristics of learning with incorporation of robotic technology.
Four hundred five patients were identified who underwent robotic surgery for endometrial cancer. Mean age was 62.2 years and mean body mass index was 32.4. Fifty-five percent of patients reported a prior abdominal surgery. Final pathologic analysis demonstrated that 89.6% of all patients had stage I and II disease. Mean operative time was 170.5 minutes. Mean estimated blood loss was 87.5 mL. Mean lymph node count was 15.5. Mean hospital stay was 1.8 days. Intraoperative complications occurred in 3.5% of the patients and conversion to laparotomy occurred in 6.7%. Postoperative complications were reported in 14.6% of the patients. For the group, fewer than 10 cases were required to achieve proficiency with the procedure.
Robotic technology may level the playing field between the novice and expert laparoscopist for endometrial cancer staging. Prospective trials should be undertaken to compare robotic and laparoscopic approaches to treat endometrial cancer.
III.
报告多机构开展的机器人辅助子宫内膜癌手术分期的围手术期结果及学习曲线特征。
成立了一个多机构机器人手术联盟，以评估机器人技术在妇科肿瘤手术中的实用性。对2003年4月至2009年1月期间所有接受机器人辅助子宫内膜癌手术患者的多机构数据库进行分析。查阅记录以获取人口统计学数据和围手术期结果。还分析了个体外科医生的结果，以评估引入机器人技术后的学习特征。
确定了405例接受机器人辅助子宫内膜癌手术的患者。平均年龄为62.2岁，平均体重指数为32.4。55%的患者报告曾接受过腹部手术。最终病理分析表明，所有患者中89.6%患有I期和II期疾病。平均手术时间为170.5分钟。平均估计失血量为87.5毫升。平均淋巴结计数为15.5。平均住院时间为1.8天。3.5%的患者发生术中并发症，6.7%的患者转为开腹手术。14.6%的患者报告有术后并发症。对于该组而言，熟练掌握该手术所需的病例数少于10例。
机器人技术可能会缩小新手和专家腹腔镜医生在子宫内膜癌分期方面的差距。应进行前瞻性试验，以比较机器人手术和腹腔镜手术治疗子宫内膜癌的方法。
III级。
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