Gastrich Mary Downes, Barone Joseph, Bachmann Gloria, Anderson Mark, Balica Adrian
Department of Obstetrics, Gynecology and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
Department of Surgery, Division of Urology, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
J Robot Surg. 2011 Jun;5(2):79-97. doi: 10.1007/s11701-011-0246-y. Epub 2011 Jan 21.
Using differing levels of evidence, we developed criteria to critically review 21 scientifically peer-reviewed articles on robot-assisted surgeries in various medical fields. The advantages and limitations of robotic systems are discussed and compared with traditional surgical methods. Since training in the use of robotic skills is essential, various training models are discussed to teach the complex skills necessary for robotic surgery. There is a paucity of control studies on a sufficient number of subjects in robot-assisted surgeries in all fields. Studies that meet more stringent clinical trials criteria show that robot-assisted surgery appears comparable to traditional surgery in terms of feasibility and outcomes but that costs associated with robot-assisted surgery are higher because of longer operating times and expense of equipment. While a limited number of studies on the da Vinci robotic system have proven the benefit of this approach in regard to patient outcomes, including significantly reduced blood loss, lower percentage of postoperative complications, and shorter hospital stays, there are mechanical and institutional risks that must be more fully addressed. In addition, trials are needed to identify simulators for learners that can enhance the da Vinci performance in order to shorten the learning curve.
我们运用不同层次的证据，制定了标准，以严格审查21篇关于各医学领域机器人辅助手术的科学同行评审文章。讨论了机器人系统的优缺点，并与传统手术方法进行了比较。由于掌握机器人操作技能的培训至关重要，因此探讨了各种培训模式，以教授机器人手术所需的复杂技能。在所有领域的机器人辅助手术中，针对足够数量受试者的对照研究都很匮乏。符合更严格临床试验标准的研究表明，机器人辅助手术在可行性和手术结果方面似乎与传统手术相当，但由于手术时间更长和设备费用高昂，机器人辅助手术的成本更高。虽然对达芬奇机器人系统的有限数量研究已证明这种方法在患者手术结果方面的益处，包括显著减少失血、降低术后并发症发生率和缩短住院时间，但仍存在机械和机构方面的风险，必须更全面地加以解决。此外，还需要进行试验，以确定能提高达芬奇机器人性能从而缩短学习曲线的模拟器，供学习者使用。
