从多孔道到单孔道手术的转变：机器人辅助经阴道子宫切除术治疗良性妇科疾病的单中心经验。
Transition from multiport to single-site surgery: A single institution experience in robotic supracervical hysterectomy for benign gynecological diseases.
机构信息
Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.
Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
出版信息
Taiwan J Obstet Gynecol. 2019 Jul;58(4):514-519. doi: 10.1016/j.tjog.2019.05.015.
OBJECTIVE
To share our experience of transition from multiport to single-site robotic surgery for benign gynecological conditions as well as to assess the selection criteria of candidates for robotic single-site supracervical hysterectomy (RSSH).
MATERIALS AND METHODS
A retrospective review was conducted on patients undergoing robotic supracervical hysterectomy by a single surgeon in a single institute between June 2014 and December 2017. Patients who underwent additional procedures along with supracervical hysterectomy and who had unexpectant corpus malignancy proved pathologically were excluded from comparisons between patients undergoing RSSH and robotic multiport supracervical hysterectomy (RMSH).
RESULTS
Between June 2014 and December 2017, we accomplished 26 RSSH and 57 RMSH. There were no conversions, intraoperative complications, and readmissions within 30 days after surgery. In the RSSH group, the mean uterine weight was 264.6 ± 140.9 g with mean docking time of 15.8 ± 5.5 min, mean console time of 61.1 ± 35.6 min and mean operative time of 140.3 ± 34.4 min. In comparison to the RMSH group, the percentage of overweight/obese patients was lower (p = 0.018) and the uterine size was smaller (p < 0.001) with adenomyosis diagnosed more frequently (p = 0.002) in the RSSH group. While the operative time in the RSSH group was significantly shorter (p = 0.002), the RSSH group took longer time in docking (p < 0.001) and comparable time in console (p = 0.254). In view of chronological change, docking time and console time in the RMSH group remained steady, whereas steep decreases were observed in the RSSH group. The intraoperative blood loss and hemoglobin drop were comparable. The length of hospital stay was significantly shorter in the RSSH group (p = 0.005).
CONCLUSION
Transition from multiport to single-site surgery can be smooth for a surgical team experienced in the conventional multiport robotic system. RSSH is safe and feasible in properly selected patients.
目的
分享我们在良性妇科疾病中从多孔位到单孔机器人手术的过渡经验，并评估机器人单孔经阴道子宫切除术（RSSH）候选人的选择标准。
材料与方法
回顾性分析 2014 年 6 月至 2017 年 12 月期间，一位外科医生在一家医院行机器人经阴道子宫切除术的患者。排除了在 RSSH 和机器人多孔位经阴道子宫切除术（RMSH）中同时进行附加手术以及意外发现子宫体恶性肿瘤的患者。
结果
2014 年 6 月至 2017 年 12 月期间，我们完成了 26 例 RSSH 和 57 例 RMSH。无中转、术中并发症和术后 30 天内再入院。在 RSSH 组中，子宫重量平均为 264.6±140.9g，平均对接时间为 15.8±5.5min，平均控制台时间为 61.1±35.6min，平均手术时间为 140.3±34.4min。与 RMSH 组相比，RSSH 组超重/肥胖患者的比例较低（p=0.018），子宫大小较小（p<0.001），诊断为腺肌病的患者比例较高（p=0.002）。虽然 RSSH 组的手术时间明显缩短（p=0.002），但 RSSH 组的对接时间更长（p<0.001），控制台时间相当（p=0.254）。从时间变化来看，RMSH 组的对接时间和控制台时间保持稳定，而 RSSH 组则明显下降。术中出血量和血红蛋白下降相当。RSSH 组的住院时间明显缩短（p=0.005）。
结论
对于经验丰富的传统多孔机器人系统的外科医生团队来说，从多孔位到单孔位手术的过渡是可以顺利进行的。在适当选择的患者中，RSSH 是安全可行的。
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