Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, USA.
J Gynecol Oncol. 2011 Dec;22(4):253-9. doi: 10.3802/jgo.2011.22.4.253. Epub 2011 Dec 5.
To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors.
Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis.
The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay.
Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.
在控制外科医生和其他混杂因素的情况下，比较全腹腔镜和机器人辅助手术用于子宫切除术和所有指征性手术的结果。
回顾性分析 2007 年 8 月至 2009 年 7 月期间由两位妇科肿瘤外科医生连续进行的全腹腔镜和达芬奇机器人子宫切除术的所有病例。我们的主要观察指标是手术操作时间。次要指标包括并发症、中转开腹、估计失血量和住院时间。采用混合模型随机截距来控制外科医生和其他混杂因素。Wilcoxon 秩和检验、卡方检验和 Fisher 确切概率法用于统计学分析。
本研究共纳入 124 例患者，其中 77 例行全腹腔镜子宫切除术，47 例行机器人子宫切除术。两组患者的基线特征、手术指征和附加手术均相似。尽管全腹腔镜子宫切除术组的标本明显更大（125g 比 94g，p=0.002），但全腹腔镜子宫切除术组（111.4 分钟）和机器人子宫切除术组（150.8 分钟）的平均手术操作时间差异具有统计学意义（p=0.0001）。机器人子宫切除术组的估计失血量明显少于全腹腔镜子宫切除术组（131.5ml 比 207.7ml，p=0.0105），但两组均无患者需要输血。两组中转开腹率、术中并发症和住院时间无统计学差异。
在经过培训的外科医生手中，全腹腔镜子宫切除术与机器人辅助手术相比，手术时间更短，安全性更高。
