Wasson Megan N, Hoffman Matthew K
Del Med J. 2015 Feb;87(2):45-50.
To determine the impact of introduction of a robotic surgical system on hysterectomy trends.
A retrospective, cohort study using longitudinal medical records from a tertiary care community hospital was used to determine the surgical approach to hysterectomy. For the purposes of analysis, surgical approaches were categorized as robotically assisted, laparoscopic, laparotomy, vaginal, or laparoscopically assisted vaginal.
A total of 4,440 women underwent a hysterectomy between January 2007 and December 2012 (benign gynecology N = 3,127, gynecologic oncology N = 1,001, urogynecology N = 312). Amongst benign gynecologists, during the five years following introduction of the robotic system, the rate of hysterectomy performed via laparotomy decreased from 62.2 percent to 39.1 percent, p-value < 0.001. The rate of robotically assisted hysterectomy increased from 0.0 percent to 26.4 percent, p-value < 0.001. When subspecialties were examined, the rate of hysterectomy performed by a gynecologic oncologist via laparotomy decreased from 89.7 percent to 20.0 percent, p-value < 0.001. The rate of robotically assisted hysterectomy increased from 0.0 percent to 78.3 percent, p-value < 0.001. Amongst urogynecologists, the rate of hysterectomy performed vaginally decreased from 80.0 percent to 33.6 percent, p-value < 0.001, while the rate of robotically assisted hysterectomy increased from 0.0 percent to 54.2 percent, p-value < 0.001.
The percentage of robotically assisted hysterectomies has dramatically increased and is now the primary modality for performing hysterectomy amongst subspecialists.
确定引入机器人手术系统对子宫切除术趋势的影响。
采用一项回顾性队列研究，利用一家三级医疗社区医院的纵向医疗记录来确定子宫切除术的手术方式。为进行分析，手术方式分为机器人辅助、腹腔镜、剖腹手术、阴道手术或腹腔镜辅助阴道手术。
2007年1月至2012年12月期间，共有4440名女性接受了子宫切除术（良性妇科疾病患者3127例，妇科肿瘤患者1001例，泌尿妇科患者312例）。在良性妇科手术中，引入机器人系统后的五年间，剖腹手术子宫切除术的比例从62.2%降至39.1%，p值<0.001。机器人辅助子宫切除术的比例从0.0%增至26.4%，p值<0.001。在对各亚专业进行检查时，妇科肿瘤医生进行的剖腹手术子宫切除术比例从89.7%降至20.0%，p值<0.001。机器人辅助子宫切除术的比例从0.0%增至78.3%，p值<0.001。在泌尿妇科医生中，经阴道子宫切除术的比例从80.0%降至33.6%，p值<0.001，而机器人辅助子宫切除术的比例从0.0%增至54.2%，p值<0.001。
机器人辅助子宫切除术的比例显著增加，现已成为各亚专业进行子宫切除术的主要方式。
