Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Department of General Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
Int J Med Robot. 2021 Apr;17(2):e2203. doi: 10.1002/rcs.2203. Epub 2020 Dec 13.
The aim was to compare intraoperative conduct of adrenalectomy between laparoscopic and robotic approaches.
Intraoperative video-recordings of patients who underwent robotic (n = 30) and laparoscopic adrenalectomy (n = 30) were analysed using Mann-Whitney U, chi-square and multivariate regression analyses.
Demographics, indications and outcomes were similar between groups. For all tumour sizes, camera was more engaged to surgical task and exhibited less vision problems in robotic versus laparoscopic group. There was less instrument exchange and restriction of exposure with robotic approach. For dissection, robotic approach allowed for a wider range of instrument reach around adrenal. Robotically, there was an increased ability to do fine dissection, rather than en bloc division with rigid laparoscopic vessel sealers. Bleeding problems were less robotically.
Despite similarities in post-operative morbidity and hospital stay, there was a superiority in quality of procedure performed with robotic versus laparoscopic adrenalectomy for both small and large adrenal tumours.
本研究旨在比较腹腔镜和机器人辅助肾上腺切除术的术中操作。
对接受机器人（n=30）和腹腔镜肾上腺切除术（n=30）的患者的术中录像进行分析，采用曼-惠特尼 U 检验、卡方检验和多变量回归分析。
两组患者的人口统计学、适应证和结果相似。对于所有肿瘤大小，与腹腔镜组相比，机器人组的摄像头更多地参与手术任务，并且视野问题较少。机器人组的器械交换和暴露限制较少。对于解剖，机器人方法允许更大范围的器械到达肾上腺周围。机器人手术可以进行更精细的解剖，而不是使用刚性腹腔镜血管密封器进行整块切除。机器人手术的出血问题较少。
尽管术后发病率和住院时间相似，但对于大小不同的肾上腺肿瘤，机器人辅助肾上腺切除术在手术质量方面优于腹腔镜手术。
