Jayakumaran J, Wiercinski K, Buffington C, Caceres A
Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, 70 West Gore Street, Orlando, FL, 34743, USA.
Florida Hospital Celebration Health, Celebration, FL, USA.
J Robot Surg. 2018 Sep;12(3):447-454. doi: 10.1007/s11701-017-0755-4. Epub 2017 Oct 13.
The da Vinci Xi surgical system was released with several upgrades and modifications compared to the previous robotic generations to facilitate minimal invasive surgery. Herein, we present our preliminary experience of robotic laparoendoscopic single-site gynecologic surgery performed for benign indications with the da Vinci Xi robotic system in a single center. Thirty-five female patients underwent robotic single-site surgery between June 2016 and January 2017. The median console time for hysterectomy with or without salpingo-oophorectomy was 41 min. The median intracorporeal vaginal cuff closure time was 18 min. Two cases (5.7%) were converted to robotic-assisted multiport surgery. There was one major intraoperative complication (2.9%). None of the patient required blood transfusion. When comparing our first 12 cases to subsequent 12 cases of R-LESS hysterectomy, there was a statistically significant decrease in surgical times and estimated blood loss. On logistic regression analysis, no association was detected between BMI and port entry time (OR 0.93, 95% CI 0.83-1.04, p = 0.23), console time (OR 0.98, 95% CI 0.94-1.02, p = 0.37), cuff closure time (OR 0.9, 95% CI 0.76-1.09, p = 0.33), operative time (OR 1, 95% CI 0.98-1.01, p = 0.97), and estimated blood loss (OR 0.98, 95% CI 0.96-1.01, p = 0.33). Our preliminary experience with robotic laparoendoscopic single-site surgery using the da Vinci Xi system has demonstrated feasibility and safety in select patients. Further studies with greater number of patients in multiple settings will help us to fully elucidate the role of da Vinci Xi surgical system in single-site gynecologic surgery.
与前代机器人手术系统相比，达芬奇Xi手术系统在发布时进行了多项升级和改进，以促进微创手术。在此，我们介绍我们在单一中心使用达芬奇Xi机器人系统为良性指征进行机器人腹腔镜单部位妇科手术的初步经验。2016年6月至2017年1月期间，35例女性患者接受了机器人单部位手术。行子宫切除术加或不加输卵管卵巢切除术的中位控制台时间为41分钟。中位体内阴道断端闭合时间为18分钟。2例（5.7%）转为机器人辅助多端口手术。有1例严重术中并发症（2.9%）。无一例患者需要输血。将我们的前12例机器人单部位子宫切除术与随后的12例进行比较时，手术时间和估计失血量有统计学意义的减少。逻辑回归分析显示，BMI与端口进入时间（OR 0.93，95%CI 0.83-1.04，p = 0.23）、控制台时间（OR 0.98，95%CI 0.94-1.02，p = 0.37）、断端闭合时间（OR 0.9，95%CI 0.76-1.09，p = 0.33）、手术时间（OR 1，95%CI 0.98-1.01，p = 0.97）和估计失血量（OR 0.98，95%CI 0.96-1.01，p = 0.33）之间均无关联。我们使用达芬奇Xi系统进行机器人腹腔镜单部位手术的初步经验已证明在特定患者中具有可行性和安全性。在多个环境中对更多患者进行进一步研究将有助于我们充分阐明达芬奇Xi手术系统在单部位妇科手术中的作用。
