Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, MBC-52, P.O. Box 3354, Riyadh, 11211, Saudi Arabia.
Department of Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, 32804, USA.
J Robot Surg. 2012 Jun;6(2):125-30. doi: 10.1007/s11701-011-0278-3. Epub 2011 May 29.
We report early experience of a case-mix series of robotic-assisted (RA) gynecologic/oncologic surgery in an Arabian population from a tertiary care facility, and discuss the emergence/growth of robotic surgery in the Arab world (Middle East). From December 2005 to December 2010, 60 consecutive patients [benign with complex pathology (BN, n = 34) and 26 cases with various malignancies; i.e., endometrial cancer (EC, n = 13), ovarian cancer (OC, n = 4), cervical cancer (CC, n = 1), and other cancers (OTH, n = 8), underwent RA procedures for the diagnosis/treatment/management of gynecologic/oncologic diseases at a single institution using the da Vinci(®) Surgical System. Data were analyzed for demographics, clinico-pathologic and peri/post-operative factors using intent-to-treat analysis. Despite continuous growth in the number of cases performed each year, the establishment of the robotic surgery program at our institution has been rather challenging due to patient acceptance, public awareness, and administrative resistance. The mean age of the case-mix was 43 ± 15 years (distribution: BN 39 ± 14, EC 61 ± 6, OC 36 ± 15, CC 50, OTH 41 ± 12 years). The body mass index for the case-mix was 30.3 ± 6.9 kg/m(2) (distribution: BN 29.7 ± 6.2, EC 34.0 ± 3.6, OC 20.0 ± 1.7, CC 48, OTH 30.2 ± 6.2 kg/m(2)). The histology of most EC cases was endometrioid adenocarcinoma. The mean operative time was case-mix 95 ± 43, BN 77 ± 26, EC 156 ± 30, OC 80 ± 35, CC 150, OTH 79 ± 23 min. Mean blood loss was case-mix 126, BN 129, EC 177, OC 67, CC 50, OTH 71 min. Two cases (3.3%) were converted to laparotomy (one each in EC and BN groups). Mean hospital length of stay was 2 days. Four cases (6.7%) experienced complications. Only 4/26 (15.4%) of cancer cases required adjuvant therapy. The data suggest that RA gynecologic/oncologic procedures are feasible and satisfactory to our Arabian patient population and comparable to the existing literature for Caucasian counterparts. We believe this report is the first (and perhaps largest) case-mix series on the early experience of RA surgery for gynecologic/oncologic cases from the Middle East.
我们报告了在一家三级医疗机构中，阿拉伯人群中机器人辅助（RA）妇科/肿瘤手术的病例组合系列的早期经验，并讨论了机器人手术在阿拉伯世界（中东）的出现/发展。从 2005 年 12 月至 2010 年 12 月，60 例连续患者[良性伴复杂病理（BN，n=34）和 26 例各种恶性肿瘤；即子宫内膜癌（EC，n=13）、卵巢癌（OC，n=4）、宫颈癌（CC，n=1）和其他癌症（OTH，n=8），在一家机构使用达芬奇®手术系统进行 RA 手术，以诊断/治疗/管理妇科/肿瘤疾病。使用意向治疗分析对人口统计学、临床病理和围手术期因素进行数据分析。尽管每年进行的手术数量不断增加，但由于患者接受度、公众意识和行政阻力，我们机构的机器人手术计划的建立仍然颇具挑战性。病例组合的平均年龄为 43±15 岁（分布：BN 39±14 岁，EC 61±6 岁，OC 36±15 岁，CC 50 岁，OTH 41±12 岁）。病例组合的体重指数为 30.3±6.9kg/m2（分布：BN 29.7±6.2kg/m2，EC 34.0±3.6kg/m2，OC 20.0±1.7kg/m2，CC 48 岁，OTH 30.2±6.2kg/m2）。大多数 EC 病例的组织学为子宫内膜样腺癌。平均手术时间为病例组合 95±43 分钟，BN 77±26 分钟，EC 156±30 分钟，OC 80±35 分钟，CC 150 分钟，OTH 79±23 分钟。平均失血量为病例组合 126ml，BN 129ml，EC 177ml，OC 67ml，CC 50ml，OTH 71ml。2 例（3.3%）转为剖腹手术（EC 组和 BN 组各 1 例）。平均住院时间为 2 天。4 例（6.7%）出现并发症。仅 4/26（15.4%）例癌症患者需要辅助治疗。数据表明，RA 妇科/肿瘤手术对我们的阿拉伯患者群体是可行且令人满意的，与白人患者的现有文献相比也是如此。我们相信，这是中东地区首例（或许也是最大的）关于 RA 手术治疗妇科/肿瘤病例的病例组合系列报告。
