Department of Obstetrics and Gynecology, IRCCS Fondazione-Policlinico San Matteo, University of Pavia, Pavia, Italy.
Arch Gynecol Obstet. 2012 Feb;285(2):441-5. doi: 10.1007/s00404-011-2005-8. Epub 2011 Jul 22.
To report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries in a teaching hospital.
A total of 33 patients who underwent robotic-assisted laparoscopic procedures for gynecological diseases were included in the study. All surgeries were performed using the double-console da Vinci surgical system. Patient's demographics, surgical procedures, operative time, perioperative complications, conversion rate, hospital stay and estimated blood loss were prospectively collected.
All procedures were completed robotically except three (9%): two cases were converted to laparotomy and one case was converted to vaginal surgery. The mean age was 47 ± 11 and mean BMI was 23 kg/m². Mean time taken for docking the robot was 22 min. Mean operative time was 152 min. Mean anesthesia time was 196 min. Mean hemoglobin drop was 2 g/dL. Four complications occurred: one transitory ischemic attack, one port-site hernia managed through trocar incision, one periumbilical hematoma managed conservatively and one vaginal cuff hematoma who required laparoscopy. The mean hospital stay was 4 days.
With the use of robotic technology, surgeons are able to offer minimally invasive surgery to a larger percentage of patients. Double console system seems a promising tool in surgical education, improving both resident training and participation in surgeries. A shorter adaption to robotics could be expected in teams with previous experience with standard laparoscopy, however, a stepwise start with simpler cases is the key to achieve a safe adaption to robotic surgery.
报告我们在教学医院中使用机器人辅助腹腔镜进行各种妇科手术的初步经验。
共有 33 名患有妇科疾病的患者接受了机器人辅助腹腔镜手术，所有手术均使用双控制台达芬奇手术系统进行。前瞻性收集患者的人口统计学、手术程序、手术时间、围手术期并发症、转化率、住院时间和估计失血量等数据。
除了 3 例（9%），所有手术均成功完成机器人辅助腹腔镜手术，这 3 例分别转为开腹手术和阴道手术。机器人对接的平均时间为 22 分钟，手术的平均时间为 152 分钟，麻醉时间的平均时间为 196 分钟，平均血红蛋白下降 2g/dL。有 4 例并发症发生：1 例短暂性脑缺血发作，1 例切口疝，1 例脐周血肿保守治疗，1 例阴道残端血肿需要腹腔镜检查。平均住院时间为 4 天。
使用机器人技术，外科医生能够为更多的患者提供微创手术。双控制台系统似乎是一种有前途的手术教学工具，可以提高住院医师的培训和手术参与度。对于有标准腹腔镜手术经验的团队来说，适应机器人技术的时间可能会缩短，但安全适应机器人手术的关键是逐步开始进行更简单的病例。
