Department of Urology, St. Elizabeth's Health Center, Youngstown, Ohio, USA.
J Endourol. 2010 Sep;24(9):1509-13. doi: 10.1089/end.2009.0573.
Robot-assisted minimally invasive surgery has become a routine surgical option for the treatment of prostate cancer. Despite its technical advancements, the da Vinci(®) Surgical System still lacks haptic feedback to the surgeon, resulting in a maximally applied compressive force by the robotic needle driver during every grasping maneuver. Without this perceptional sense of touch and grip control, repetitive robotic needle driver manipulation may unknowingly lead to irreparable damage to fine sutures used during delicate anastomotic repairs. For robotic prostatectomy, any such loss of integrity can potentially lead to premature breakdown of the urethrovesical anastomosis and urine extravasation, especially important for a less-than-perfectly fashioned anastomotic repair. Although it has already been established that overhandling of sutures using handheld laparoscopic instruments can lead to reduced suture strength, it has not been established to what extent this may occur after robotic surgical procedures. We present analytical data and analyses concerning the failure strength of fine sutures commonly used for urethrovesical anastomotic repair during robotic prostatectomy, after repetitive robotic needle driver manipulation. When compared with noncompromised monofilament suture controls, the average maximal failure force after repetitive robotic manipulation was significantly reduced by 35% (p < 0.0001). Similarly, the average maximal failure force of braided sutures was significantly reduced after repetitive robotic manipulation by 3% (p = 0.009). This work demonstrates that significant reductions in monofilament and braided suture strength integrity can occur after customary repetitive manipulation by robotic needle drivers in an ex vivo model, with further research warranted in the in vivo setting.
机器人辅助微创手术已成为治疗前列腺癌的常规手术选择。尽管达芬奇（®）手术系统在技术上有所进步，但仍然缺乏对医生的触觉反馈，从而导致机器人针驱动器在每次抓握操作中施加最大的压缩力。没有这种感知触觉和抓握控制，重复的机器人针驱动器操作可能会在不知不觉中导致在精细吻合修复过程中使用的精细缝线不可挽回的损坏。对于机器人前列腺切除术，任何此类完整性的损失都可能导致尿道膀胱吻合口过早破裂和尿液外渗，对于不太完美的吻合修复尤其重要。虽然已经确定使用手动腹腔镜器械过度处理缝线会导致缝线强度降低，但尚未确定在机器人手术后会在多大程度上发生这种情况。我们提出了关于机器人前列腺切除术后重复机器人针驱动器操作后用于尿道膀胱吻合修复的精细缝线失效强度的分析数据和分析。与未受损的单丝缝线对照相比，重复机器人操作后的平均最大失效力显著降低了 35%（p < 0.0001）。同样，重复机器人操作后编织缝线的平均最大失效力也显著降低了 3%（p = 0.009）。这项工作表明，在体外模型中，常规重复机器人针驱动器操作后，单丝和编织缝线的强度完整性会显著降低，在体内环境中需要进一步研究。
