挑战性情况下机器人辅助显微手术与手动显微手术的比较
A Comparison of Robotically Assisted Microsurgery versus Manual Microsurgery in Challenging Situations.
作者信息
Willems Joost I P, Shin Alexandra M, Shin Delaney M, Bishop Allen T, Shin Alexander Y
机构信息
Rochester, Minn.
From the Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic.
出版信息
Plast Reconstr Surg. 2016 Apr;137(4):1317-1324. doi: 10.1097/PRS.0000000000002030.
BACKGROUND
Microsurgery can be challenging secondary to orientation of the vessels, accessibility, or depth of the wound. Robotically assisted microsurgery reduces tremors and improves visualization and may improve the quality of anastomosis compared with traditional microsurgery. The purpose of this study was to compare robotically assisted microsurgery to traditional microsurgery in technically challenging situations with respect to time of anastomosis, quality of anastomosis, and Objective Structured Assessment of Technical Skills.
METHODS
Two investigators with no prior surgery or microsurgery experience performed 160 anastomoses on artificial microvessels after undergoing standardized traditional and robotically assisted microsurgery courses. Five different exposure groups were created with depths of 0, 10, and 20 cm and sidewall angles of 20 and 30 degrees. A comparison of 80 manual with 80 robotically assisted microsurgery anastomoses in different exposure groups was undertaken. The modified Objective Structured Assessment of Technical Skills scoring system, duration per anastomosis, and a subjective comfort scale were evaluated.
RESULTS
In the most difficult exposure, Objective Structured Assessment of Technical Skills scores were similar in both groups (p = 0.98), the duration was higher in the manual group (p = 0.004), and the subjective comfort rating was higher in the robotically assisted microsurgery group (p < 0.001). In the easiest (0-cm depth, flat) exposure, Objective Structured Assessment of Technical Skills scores were higher in the manual group (p = 0.018) and the duration was longer in the robotically assisted microsurgery group (p = 0.008).
CONCLUSIONS
Manual surgery was superior to robotically assisted microsurgery in technically easy exposures. In difficult exposures (greater depth and lower sidewall angles), however, robotically assisted microsurgery had a shorter surgery time and a higher comfort rating, with Objective Structured Assessment of Technical Skills scores similar to those assessing traditional microsurgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
背景
由于血管的方向、可及性或伤口深度，显微外科手术可能具有挑战性。与传统显微外科手术相比，机器人辅助显微外科手术可减少震颤并改善可视化效果，还可能提高吻合质量。本研究的目的是在技术上具有挑战性的情况下，比较机器人辅助显微外科手术与传统显微外科手术在吻合时间、吻合质量和客观结构化技术技能评估方面的差异。
方法
两名没有手术或显微外科手术经验的研究者在接受标准化的传统和机器人辅助显微外科手术课程培训后，对人工微血管进行了160次吻合。创建了五个不同的暴露组，深度分别为0、10和20厘米，侧壁角度分别为20度和30度。对不同暴露组中的80次手动吻合和80次机器人辅助显微外科手术吻合进行了比较。评估了改良的客观结构化技术技能评分系统、每次吻合的持续时间和主观舒适度量表。
结果
在最困难的暴露情况下，两组的客观结构化技术技能评分相似（p = 0.98），手动组的持续时间更长（p = 0.004），机器人辅助显微外科手术组的主观舒适度评分更高（p < 0.001）。在最容易的（0厘米深度，平坦）暴露情况下，手动组的客观结构化技术技能评分更高（p = 0.018），机器人辅助显微外科手术组的持续时间更长（p = 0.008）。
结论
在技术上容易的暴露情况下，手动手术优于机器人辅助显微外科手术。然而在困难的暴露情况下（更深的深度和更低的侧壁角度），机器人辅助显微外科手术的手术时间更短，舒适度评分更高，客观结构化技术技能评分与评估传统显微外科手术的评分相似。
临床问题/证据水平：治疗性，V级
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