Meenakshi-Sundaram B, Furr J R, Malm-Buatsi E, Boklage B, Nguyen E, Frimberger D, Palmer B W
Department of Urology, Children's Hospital at OU Medical Center, Oklahoma City, OK, USA.
Department of Urology, Children's Hospital at OU Medical Center, Oklahoma City, OK, USA.
J Pediatr Urol. 2017 Oct;13(5):489.e1-489.e5. doi: 10.1016/j.jpurol.2017.01.017. Epub 2017 Feb 24.
The adoption of robot-assisted laparoscopic (RAL) procedures in the field of urology has occurred rapidly, but is, to date, without pediatric-specific instrumentation. Surgical fog is a significant barrier to safe and efficient laparoscopy. This appears to be a significant challenge when adapting three-dimensional 8.5-mm scopes to use in pediatric RAL surgery. The objective of the present study was to compare matched controls from a prospectively collected database to procedures that were performed utilizing special equipment and a protocol to minimize surgical fog in pediatric RAL procedures.
A prospectively collected database of all patients who underwent RAL pediatric urology procedures was used to compare: procedure, age, sex, American Society of Anesthesiologists score, weight, console time, number of times the camera was removed to clean the lens during a procedure, length of hospital stay, and morphine equivalents required in the postoperative period. A uniquely developed protocol was used, it consisted of humidified (95% relative humidity) and warmed CO gas (95 °F) insufflation via Insuflow® on a working trocar, with active smoke evacuation via PneuVIEW®XE on the opposite working trocar with a gas pass through of 3.5-5 l/min. The outcomes were compared with matched controls (Summary Fig).
The novel gas protocol was utilized in 13 procedures (five pyeloplasties, two revision pyeloplasties, three ureteroureterostomies (UU), three nephrectomies) and compared with 13 procedures (six pyeloplasties, one revision pyeloplasty, three UU, three nephrectomies) prior to the protocol development. There was no statistical difference in age (P = 0.78), sex (P = 0.11), ASA score (P = 1.00) or weight (P = 0.69). There were no open conversions, ≥Grade 2 Clavien complications, or readmissions within 30 days in either group.
This novel gas protocol yielded a statistically significant reduction in procedure time, by decreasing the number of times the camera was required to be pulled during the case by more than five occurrences, and saved approximately 35 min on average per case.
机器人辅助腹腔镜（RAL）手术在泌尿外科领域的应用发展迅速，但迄今为止，尚无专门用于儿科的器械。手术烟雾是安全、高效进行腹腔镜手术的重大障碍。在将三维8.5毫米镜头应用于儿科RAL手术时，这似乎是一个重大挑战。本研究的目的是将前瞻性收集数据库中的匹配对照组与使用特殊设备和方案以尽量减少儿科RAL手术中手术烟雾的手术进行比较。
使用前瞻性收集的所有接受RAL儿科泌尿外科手术患者的数据库，比较手术、年龄、性别、美国麻醉医师协会评分、体重、控制台时间、手术过程中摄像头因清洁镜头而取出的次数、住院时间以及术后所需的吗啡等效剂量。采用了一种独特开发的方案，包括通过工作套管针上的Insuflow®进行加湿（相对湿度95%）和加温（95°F）的CO₂气体吹入，并通过对侧工作套管针上的PneuVIEW®XE进行主动烟雾抽吸，气体通过量为3.5 - 5升/分钟。将结果与匹配对照组进行比较（总结图）。
在13例手术（5例肾盂成形术、2例肾盂成形术翻修术、3例输尿管输尿管吻合术（UU）、3例肾切除术）中采用了新的气体方案，并与方案制定前的13例手术（6例肾盂成形术、1例肾盂成形术翻修术、3例UU、3例肾切除术）进行比较。年龄（P = 0.78）、性别（P = 0.11）、ASA评分（P = 1.00）或体重（P = 0.69）方面无统计学差异。两组均无开放手术转换、≥2级Clavien并发症或30天内再入院情况。
这种新的气体方案在统计学上显著缩短了手术时间，使术中摄像头需要拔出的次数减少了五次以上，平均每例节省约35分钟。
