Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Gynecol Oncol. 2012 Sep;126(3):432-6. doi: 10.1016/j.ygyno.2012.05.017. Epub 2012 May 18.
Minimally invasive surgical techniques decrease surgical morbidity and recovery time. Studies demonstrate similar surgical outcomes comparing robotic to laparoscopic surgery. These studies have not accounted for the incorporation of fellow education. With the dual-console da Vinci Si Surgical System®, a two surgeon approach could be performed. We sought to compare surgical outcomes at a gynecologic oncology fellowship program of traditional laparoscopic to robotic surgeries using the dual-console system.
We identified patients who underwent laparoscopic or robotic surgery performed by a gynecologic oncologist from November 2009-November 2010. Robotic surgeries were conducted using the dual-console, utilizing a two surgeon approach. Surgeries involved a staff physician with a gynecologic oncology fellow. Statistical analysis was performed using student t-test and chi-squared analysis.
A total of 222 cases were identified. Cases were analyzed in groups: all cases identified, all cancer cases, and endometrial cancer cases only. When analyzing all cases, no statistical difference was noted in total operating room time (172 vs. 175 min; p=0.6), pelvic lymph nodes removed (10.1 vs. 9.6; p=0.69), para-aortic lymph nodes dissected (3.7 vs. 3.8; p=0.91), or length of stay (1.5 vs. 1.3 days; p=0.3). There was a significant difference in total surgical time (131 vs.110 min; p<0.0001) and EBL (157 vs.94 ml; p<0.0001), favoring robotic surgery. When analyzing all cancer cases, the advantage in total surgical time for robotic surgery was lost. Complications were similar between cohorts.
Incorporating fellow education into robotic surgery does not adversely affect outcomes when compared to traditional laparoscopic surgery.
微创手术技术降低了手术发病率和恢复时间。研究表明，机器人手术与腹腔镜手术的手术结果相似。这些研究没有考虑到同伴教育的纳入。有了双控制台达芬奇 Si 手术系统，就可以进行双外科医生手术。我们试图比较妇科肿瘤学 fellowship 项目中传统腹腔镜手术和机器人手术的手术结果，使用双控制台系统。
我们确定了 2009 年 11 月至 2010 年 11 月期间由妇科肿瘤学家进行的腹腔镜或机器人手术的患者。机器人手术使用双控制台进行，采用双外科医生手术方法。手术涉及一名有妇科肿瘤学研究员的主治医生。使用学生 t 检验和卡方分析进行统计分析。
共确定了 222 例病例。病例按以下组进行分析：所有病例、所有癌症病例和仅子宫内膜癌病例。在分析所有病例时，总手术室时间（172 与 175 分钟；p=0.6）、盆腔淋巴结切除（10.1 与 9.6；p=0.69）、主动脉旁淋巴结清扫（3.7 与 3.8；p=0.91）或住院时间（1.5 与 1.3 天；p=0.3）无统计学差异。机器人手术的总手术时间（131 与 110 分钟；p<0.0001）和 EBL（157 与 94ml；p<0.0001）有显著差异，有利于机器人手术。在分析所有癌症病例时，机器人手术的总手术时间优势丧失。两组并发症相似。
将同伴教育纳入机器人手术与传统腹腔镜手术相比，不会对手术结果产生不利影响。
