Tarr Megan E, Brancato Sam J, Cunkelman Jacqueline A, Polcari Anthony, Nutter Benjamin, Kenton Kimberly
Division of Female Medicine and Reconstructive Surgery, Departments of Obstetrics/Gynecology and Urology, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio.
J Minim Invasive Gynecol. 2015 Feb;22(2):234-8. doi: 10.1016/j.jmig.2014.10.004. Epub 2014 Oct 12.
To compare resident, fellow, and attending urologic and gynecologic surgeons' musculoskeletal and mental strain during laparoscopic and robotic sacrocolpopexy.
Prospective cohort study (Canadian Task Force classification II-2).
Academic medical center.
Patients who underwent robotic or laparoscopic sacrocolpopexy from October 2009 to January 2011.
The Body Part Discomfort (BPD) survey was completed before cases, and the National Aeronautics and Space Administration Task Load Index and BPD survey were completed after cases. Higher scores on BPD and the National Aeronautics and Space Administration Task Load Index indicate greater musculoskeletal discomfort and mental strain. BPD scores were averaged over the following body regions: head/neck, back, hand/wrist, arms, and knees/ankles/feet. Changes in body region-specific discomfort scores were the primary outcomes.
Multivariable analysis was performed using mixed-effects linear regression with surgeon as a random effect. Sixteen surgeons participated (53% fellows, 34% residents, and 13% attendings). Thirty-three robotic and 53 laparoscopic cases were analyzed, with a median surgical time of 231 minutes (interquartile range, 204-293 minutes) versus 227 minutes (interquartile range, 203-272 minutes; p = .31), a median estimated blood loss of 100 mL (interquartile range, 50-175 mL) versus 150 mL (interquartile range, 50-200 mL; p = .22), and a mean patient body mass index of 27 ± 4 versus 26 ± 4 kg/m(2) (p = .26), respectively. Robotic surgeries were associated with lower neck/shoulder (-0.19 [interquartile range, -0.32 to -0.01], T = -2.49) and back discomfort scores (-0.35 [interquartile range, -0.58 to 0], T = -2.38) than laparoscopic surgeries. Knee/ankle/foot and arm discomfort increased with case length (0.18 [interquartile range, 0.02-0.3], T = 2.81) and (0.07 [interquartile range, 0.01-0.14], p = .03), respectively.
Surgeons performing minimally invasive sacrocolpopexy experienced less neck, shoulder, and back discomfort when surgery was performed robotically.
比较住院医师、专科住院医师以及泌尿外科和妇科主治医师在腹腔镜和机器人辅助骶骨阴道固定术中的肌肉骨骼及精神紧张程度。
前瞻性队列研究（加拿大工作组分类II-2）。
学术医疗中心。
2009年10月至2011年1月期间接受机器人辅助或腹腔镜骶骨阴道固定术的患者。
术前完成身体部位不适（BPD）调查，术后完成美国国家航空航天局任务负荷指数和BPD调查。BPD和美国国家航空航天局任务负荷指数得分越高表明肌肉骨骼不适和精神紧张程度越高。BPD得分按以下身体部位进行平均：头/颈、背部、手/腕、手臂以及膝/踝/足。特定身体部位不适得分的变化为主要结局。
采用以外科医生为随机效应的混合效应线性回归进行多变量分析。16名外科医生参与研究（53%为专科住院医师，34%为住院医师，13%为主治医师）。分析了33例机器人辅助手术和53例腹腔镜手术，中位手术时间分别为231分钟（四分位间距，204 - 293分钟）和227分钟（四分位间距，203 - 272分钟；p = 0.31），中位估计失血量分别为100 mL（四分位间距，50 - 175 mL）和150 mL（四分位间距，50 - 200 mL；p = 0.22），患者平均体重指数分别为27±4和26±4 kg/m²（p = 0.26）。与腹腔镜手术相比，机器人辅助手术患者的颈部/肩部（-0.19[四分位间距，-0.32至-0.01]，T = -2.49）和背部不适得分更低（-0.35[四分位间距，-0.58至0]，T = -2.38）。膝/踝/足和手臂不适分别随手术时长增加（0.18[四分位间距，0.02 - 0.3]，T = 2.81）和（0.07[四分位间距，0.01 - 0.14]，p = 0.03）。
进行微创骶骨阴道固定术时，机器人辅助手术的外科医生颈部、肩部和背部不适程度较低。
