Carter-Brooks Charelle M, Du Angela L, Bonidie Michael J, Shepherd Jonathan P
From the Division of Pelvic Reconstructive Surgery and Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh, Pittsburgh, PA.
Female Pelvic Med Reconstr Surg. 2018 Jan/Feb;24(1):13-16. doi: 10.1097/SPV.0000000000000413.
Robotic-assisted sacrocolpopexy has been criticized for high cost. A strategy to increase operating room efficiency and decrease cost is implementation of a dedicated robotic team. Our objective was to determine if a dedicated robotic team decreases operative time.
This institutional review board-approved retrospective cohort study included all robotic-assisted sacrocolpopexy performed from June 2010 to August 2015 by a single surgeon at 2 institutions in 1 health system. One hospital had a dedicated robotic team, whereas the other did not. To assess baseline differences, χ and t tests were used. Multivariable linear regression identified factors impacting operative time.
Eighty-eight robotic-assisted sacrocolpopexy cases met inclusion criteria. Subjects were primarily white (92.8%) and postmenopausal (85.5%) with stage III prolapse (71.1%). Mean age was 60.6 ± 9.0 years, and BMI was 28.5 ± 5.1 kg/m. Seventeen cases (19.3%) had a dedicated team. In the 71 cases without a dedicated team, there were 16 different surgical technologist and no advanced practice providers. Groups had similar baseline characteristics (all P > 0.05).Mean operative time for the dedicated team was significantly less (131.8 vs 160.2 minutes, P < 0.001), a 17.7% time reduction. The decrease persisted on multivariable regression (β = -25.98 minutes, P < 0.001) after adjusting for case order on the day (β = -8.6 minutes, P = 0.002) and prior to hysterectomy (β = -36.1 minutes, P < 0.001). Operative complications and prolapse recurrence were low overall and not different between the dedicated and nondedicated teams (0% vs 2.9%, P = 0.50; 0% vs 7.5%, P = 0.29).
A dedicated robotic team during robotic-assisted sacrocolpopexy significantly decreased operative time by 26 minutes, a 17.7% reduction at our institution.
机器人辅助骶骨阴道固定术因成本高昂而受到批评。提高手术室效率和降低成本的一种策略是组建专门的机器人手术团队。我们的目的是确定专门的机器人手术团队是否能缩短手术时间。
这项经机构审查委员会批准的回顾性队列研究纳入了2010年6月至2015年8月期间由1个医疗系统中2家机构的1名外科医生实施的所有机器人辅助骶骨阴道固定术。其中一家医院有专门的机器人手术团队，而另一家没有。为评估基线差异，采用了χ检验和t检验。多变量线性回归确定了影响手术时间的因素。
88例机器人辅助骶骨阴道固定术病例符合纳入标准。研究对象主要为白人（92.8%）、绝经后女性（85.5%），Ⅲ期脱垂患者占71.1%。平均年龄为60.6±9.0岁，体重指数为28.5±5.1kg/m²。17例（19.3%）有专门的手术团队。在71例没有专门手术团队的病例中，有16名不同的手术技师，且没有高级执业人员。两组的基线特征相似（所有P>0.05）。专门手术团队的平均手术时间显著缩短（131.8分钟对160.2分钟，P<0.001），缩短了17.7%。在对当天的病例顺序（β=-8.6分钟，P=0.002）和子宫切除术之前（β=-36.1分钟，P<0.001）进行调整后，多变量回归分析中这种缩短仍然存在（β=-25.98分钟，P<0.001）。总体手术并发症和脱垂复发率较低，专门手术团队和非专门手术团队之间无差异（0%对2.9%，P=0.50；0%对7.5%，P=0.29）。
在机器人辅助骶骨阴道固定术中，专门的机器人手术团队显著缩短了手术时间26分钟，在我们机构缩短了17.7%。
