CSTAR (Canadian Surgical Technologies and Advanced Robotics), Lawson Health Research Institute, London, ON, Canada.
Surg Endosc. 2010 Mar;24(3):584-8. doi: 10.1007/s00464-009-0621-1. Epub 2009 Jul 25.
We used a model of biliary-enteric anastomosis to test whether da Vinci robotics improves performance on a complex minimally invasive surgical (MIS) procedure.
An ex vivo model for choledochojejunostomy was created using porcine livers with extrahepatic bile ducts and contiguous intestines. MIS choledochojejunostomies were performed in two arms: group 1 (laparoscopic, n = 30) and group 2 (da Vinci assisted, n = 30). Procedures were performed by three surgeons with graduated MIS expertise: surgeon A (MIS + robotics), surgeon B (experienced MIS), and surgeon C (basic MIS). Each surgeon performed ten procedures per group. The primary objective was time to complete anastomoses using each method. Secondary objectives included anastomosis quality, impact of experience on performance, and learning curve.
da Vinci led to faster anastomoses than laparoscopy (28.0 vs. 35.9 min, p = 0.002). Surgeon A's mean operative times were equivalent with both techniques (24.5 vs. 22.3 min). Surgeons B and C experienced faster operative times with robotics over laparoscopy alone (39.4 vs. 28.6 min, p = 0.01; and 43.8 vs. 33.0 min, p = 0.008, respectively). Surgeon A did not demonstrate a learning curve with either laparoscopy (22.4 vs. 22.4 min, p = not significant, NS) or robotics (24.7 vs. 19.8 min, p = NS). Surgeon B demonstrated nonsignificant improvement with laparoscopy (46.6 vs. 39.5 min, p = NS). With robotic assistance, a learning curve was demonstrated (36.8 vs. 24.7 min, p = 0.02). Surgeon C demonstrated a learning curve with laparoscopy (58.3 vs. 33.2 min, p = 0.004), but no improvement was noted with robot assistance (32.2 vs. 34.7 min, p = NS).
da Vinci improves time to completion and quality of choledochojejunostomy over laparoscopy in an ex vivo bench model. This advantage is more pronounced in the hands of surgeons with less MIS experience. Conversely, robotics may allow less experienced surgeons to perform more complex operations without first developing advanced laparoscopic skills; however, there may be benefit to first obtaining fundamental skills.
我们使用胆管肠吻合术模型来测试达芬奇机器人是否能提高复杂微创外科（MIS）手术的操作性能。
使用具有肝外胆管和连续肠段的猪肝脏创建了胆肠吻合术的离体模型。MIS 胆肠吻合术在两个臂中进行：组 1（腹腔镜，n = 30）和组 2（达芬奇辅助，n = 30）。由三位具有不同 MIS 经验的外科医生进行手术：外科医生 A（MIS + 机器人）、外科医生 B（经验丰富的 MIS）和外科医生 C（基础 MIS）。每位外科医生每组进行 10 例手术。主要目标是使用每种方法完成吻合的时间。次要目标包括吻合质量、经验对性能的影响和学习曲线。
达芬奇机器人辅助手术比腹腔镜手术更快完成吻合（28.0 分钟对 35.9 分钟，p = 0.002）。外科医生 A 使用两种技术的平均手术时间相当（24.5 分钟对 22.3 分钟）。外科医生 B 和 C 使用机器人辅助手术比单独使用腹腔镜手术更快（39.4 分钟对 28.6 分钟，p = 0.01；43.8 分钟对 33.0 分钟，p = 0.008）。外科医生 A 在腹腔镜（22.4 分钟对 22.4 分钟，p = 不显著，NS）或机器人（24.7 分钟对 19.8 分钟，p = NS）下均未表现出学习曲线。外科医生 B 在腹腔镜下显示出非显著的改善（46.6 分钟对 39.5 分钟，p = NS）。使用机器人辅助手术，表现出学习曲线（36.8 分钟对 24.7 分钟，p = 0.02）。外科医生 C 在腹腔镜下表现出学习曲线（58.3 分钟对 33.2 分钟，p = 0.004），但机器人辅助手术没有改善（32.2 分钟对 34.7 分钟，p = NS）。
达芬奇机器人在离体模型中提高了胆管肠吻合术的完成时间和质量，优于腹腔镜手术。在经验较少的外科医生手中，这种优势更为明显。相反，机器人技术可能允许经验不足的外科医生在不首先发展先进的腹腔镜技能的情况下进行更复杂的手术；然而，首先获得基本技能可能会带来好处。
