Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria; Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany.
Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany.
Eur Urol Focus. 2017 Oct;3(4-5):413-420. doi: 10.1016/j.euf.2016.11.006. Epub 2016 Nov 26.
BACKGROUND: Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. OBJECTIVE: To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. DESIGN, SETTING, AND PARTICIPANTS: Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. RESULTS AND LIMITATIONS: The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (p<0.001) and similar to da Vinci surgery. After completing Tasks IV, V, and VI conventionally, 12 (80%), 13 (86.7%), and 13 (86.7%) of the 15 trainees, respectively, reported heavy total discomfort. The full laparoscopic system nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. CONCLUSIONS: The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. PATIENT SUMMARY: The study was conducted in a pelvi trainer and no patients were recruited.
背景：姿势、视野和仪器限制是传统腹腔镜的主要困境。
目的：将 ETHOS 手术椅、三维腹腔镜和 Radius Surgical System 操作臂结合起来，与传统腹腔镜和达芬奇机器人手术系统相比，评估在完成任务时间和舒适度方面的表现。
设计、环境和参与者：15 名学员在骨盆训练器上完成了 Heilbronn 培训计划的三个主要腹腔镜缝合任务（IV：模拟背静脉复合体缝合；V：管状结构的环形缝合；VI：尿道膀胱吻合术）。这些任务分别以传统方式、使用三种设备和机器人方式完成。记录任务完成时间，并使用问卷调查评估外科医生的舒适度。
测量结果和统计分析：使用非参数 Wilcoxon 符号秩检验比较任务完成时间，使用 Pearson 卡方检验比较人体工程学评分。
结果和局限性：与传统腹腔镜相比，使用完整的腹腔镜设备（ETHOS 手术椅、三维腹腔镜摄像头、Radius Surgical System 持针器）显著提高了三个测试任务的完成时间（p<0.001），与达芬奇手术相似。在传统方式下完成任务 IV、V 和 VI 后，分别有 12 名（80%）、13 名（86.7%）和 13 名（86.7%）学员报告总不适感较重。完整的腹腔镜系统使任务 IV 和 V 的重度不适感消失，并使最具挑战性的任务 VI 的不适感最小化（6.7%）。特别是对于任务 VI，所有学员都受益于该系统，在任务完成时间和舒适度方面都得到了改善。学员有限的机器人操作经验和问卷调查的主观性可能是一个潜在的局限性。
结论：该人体工程学腹腔镜系统在完成任务时间和人体工程学方面比传统腹腔镜有显著改善，并且与机器人手术系统具有可比性。
患者总结：该研究在骨盆训练器上进行，未招募患者。
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