Jayaraman Shiva, Davies Ward, Schlachta Christopher M
Canadian Surgical Technologies and Advanced Robotics, London Health Sciences Centre, London, Ont.
Can J Surg. 2009 Oct;52(5):374-8.
The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery.
Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve.
There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations.
Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures.
机器人技术在普通外科中的价值可能在于先进的微创手术。与其他专科不同，机器人普通外科的正规专科培训机会很少。因此，目前大多数外科医生在实践中培养机器人技术技能。我们的目标是确定机器人胆囊切除术是否是通向普通外科先进机器人技术的安全有效的桥梁。
在进行先进的机器人手术之前，两名外科医生完成了直观手术公司的达芬奇培训课程，并同意共同参与所有手术。临床手术从达芬奇胆囊切除术开始，计划在至少进行10例胆囊切除术后开始进行先进手术。我们对我们的机器人胆囊切除术试点系列进行了回顾性分析，并将其与同期的腹腔镜对照组进行了比较。主要结果是安全性，次要结果是学习曲线。
机器人手术组有16例手术，腹腔镜手术组有20例手术。机器人手术组发生了2例并发症（达芬奇端口部位疝、肝酶短暂升高），而腹腔镜手术组只有1例患者（麻醉苏醒缓慢）出现并发症。均无显著意义。进行机器人胆囊切除术所需的平均时间明显长于腹腔镜手术（91分钟对41分钟，p<0.001）。机器人手术清理手术室的平均时间明显更长（14分钟对11分钟，p=0.015）。我们观察到一种趋势，即机器人手术的平均麻醉时间更长（23分钟对15分钟）。关于学习曲线，前3例机器人手术所需的平均手术时间比后3例长（101分钟对80分钟）；然而，这种差异并不显著。自这次经验以来，该团队已自信地继续进行机器人胆道、胰腺、胃食管、肠道和结直肠手术。
机器人胆囊切除术可以可靠地进行；然而，由于手术室资源的显著增加，常规使用是不合理的。然而，我们的经验表明，机器人胆囊切除术是普通外科医生在进行先进的机器人手术时获得信心的一种方式。
