Gobern Joseph M, Rosemeyer C J, Barter James F, Steren Albert J
Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
JSLS. 2013 Jan-Mar;17(1):116-20. doi: 10.4293/108680812X13517013317473.
To evaluate the operative outcomes between robotic, laparoscopic, and abdominal myomectomies performed by a private gynecologic oncology practice in a suburban community hospital.
The medical records of 322 consecutive robotic, laparoscopic, and abdominal myomectomies performed from January 2007 through December 2009 were reviewed. The outcomes were collected from a retrospective review of patient medical records.
Records for 14/322 (4.3%) patients were incomplete. Complete data were available for 308 patients, including 169 (54.9%) abdominal, 73 (23.7%) laparoscopic, and 66 (21.4%) robotic-assisted laparoscopic myomectomies. Patients were similar in age, body mass index, parity, and previous abdominopelvic surgery. Median operative time for robotic surgery (140 min) was significantly longer (P<.005) compared to laparoscopic (70 min) and abdominal (72 min) myomectomies. Robotic and laparoscopic myomectomies had significantly less estimated blood loss and hospital stay compared to abdominal myomectomies. There was no significant difference in complications or in the median size of the largest myoma removed between the different modalities. However, the median aggregate weight of myomas removed abdominally (200g; range, 1.4 to 2682) was significantly larger than that seen laparoscopically (115g; range, 1 to 602) and robotically (129g; range 9.4 to 935). Postoperative transfusion was significantly less frequent in robotic myomectomies compared to laparoscopic and abdominal myomectomies.
While robotic-assisted laparoscopic myomectomies had longer operative times, laparoscopic and robotic assisted laparoscopic myomectomies demonstrated shorter hospital stays, less blood loss, and fewer transfusions than abdominal myomectomies. Robotic myomectomy offers a minimally invasive alternative for management of symptomatic myoma in a community hospital setting.
评估一家郊区社区医院的私立妇科肿瘤诊所实施的机器人辅助、腹腔镜及开腹子宫肌瘤剔除术的手术效果。
回顾了2007年1月至2009年12月期间连续实施的322例机器人辅助、腹腔镜及开腹子宫肌瘤剔除术的病历。通过对患者病历的回顾性分析收集结果。
322例患者中有14例（4.3%）的记录不完整。308例患者有完整数据，其中169例（54.9%）为开腹手术，73例（23.7%）为腹腔镜手术，66例（21.4%）为机器人辅助腹腔镜子宫肌瘤剔除术。患者在年龄、体重指数、产次及既往腹部盆腔手术方面相似。机器人手术的中位手术时间（140分钟）显著长于腹腔镜手术（70分钟）和开腹手术（72分钟）（P<0.005）。与开腹子宫肌瘤剔除术相比，机器人辅助和腹腔镜子宫肌瘤剔除术的估计失血量和住院时间显著更少。不同手术方式在并发症或切除的最大肌瘤中位大小方面无显著差异。然而，开腹切除的肌瘤中位总重量（200克；范围1.4至2682克）显著大于腹腔镜手术（115克；范围1至602克）和机器人手术（129克；范围9.4至935克）。机器人子宫肌瘤剔除术后输血频率显著低于腹腔镜和开腹子宫肌瘤剔除术。
虽然机器人辅助腹腔镜子宫肌瘤剔除术手术时间较长，但腹腔镜和机器人辅助腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤剔除术相比，住院时间更短、失血量更少且输血更少。机器人子宫肌瘤剔除术为社区医院环境中症状性肌瘤的管理提供了一种微创替代方法。
