Robotic Surgery, Department of Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA.
Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio, USA.
J Endourol. 2021 Aug;35(8):1163-1167. doi: 10.1089/end.2020.1059. Epub 2021 Apr 13.
Suction during robotic surgery has traditionally been performed by a bedside assistant. Adequately skilled assistants are not always available. We assessed a purpose-designed robotic surgeon-controlled suction catheter for efficiency and safety by comparing with historic cases of suction controlled by a dedicated bedside assistant using standard rigid laparoscopic suction. Beginning in February 2019, the remotely operated suction irrigation (ROSI) device was used in all robotic prostatectomy procedures, which is a flexible suction catheter manipulated by the surgeon such that a bedside assistant is never required for suction. The initial 300 consecutive cases performed with ROSI were compared with the 300 immediately previous procedures using bedside assistant suction (BAS). There were no statistically significant differences between groups in age, body mass index, American Anesthesiologist Association score, prostate specific antigen, or pathologic stage. Lymph node dissection was performed in all 600 patients. All 300 ROSI cases were completed without requiring switching to BAS. Estimated blood loss (102.7 120.2 mL, = 0.001) and operative time (156.1 149.3 minutes, < 0.001) were slightly lower in the ROSI group. There was no statistical difference in the 90-day complication rate (Clavien ≥III) between groups, with both having 3% of patients readmitted or seen in the emergency department within 90 days of surgery. Surgeon-controlled suction allowed more surgeon autonomy without a negative impact on efficiency or safety issues requiring "bailout" suctioning by the bedside assistant whether urgent or otherwise. Robotic surgeons without access to skilled bedside assistants should consider suctioning for themselves not unlike the norm for many laparoscopic surgeons.
在机器人手术中，传统上由床边助手进行抽吸。并非总是有足够熟练的助手。我们通过将由专门的床边助手控制的标准刚性腹腔镜抽吸与使用专用机器人控制的抽吸进行比较，评估了一种专门设计的机器人外科医生控制的抽吸导管的效率和安全性。从 2019 年 2 月开始，所有机器人前列腺切除术均使用远程操作抽吸冲洗（ROSI）装置，这是一种由外科医生操作的柔性抽吸导管，因此不需要床边助手进行抽吸。将最初的 300 例连续 ROSI 病例与使用床边助手抽吸（BAS）的 300 例立即前例进行比较。两组在年龄、体重指数、美国麻醉师协会评分、前列腺特异性抗原或病理分期方面均无统计学差异。所有 600 例患者均行淋巴结清扫术。所有 300 例 ROSI 病例均无需切换至 BAS 即可完成。ROSI 组的估计失血量（102.7 ± 120.2ml， = 0.001）和手术时间（156.1 ± 149.3 分钟， < 0.001）略低。两组 90 天并发症发生率（Clavien ≥III）无统计学差异，均有 3%的患者在手术后 90 天内再次入院或在急诊室就诊。外科医生控制的抽吸允许外科医生更大的自主权，而不会对效率或安全性问题产生负面影响，不需要床边助手进行“救助”抽吸，无论是紧急情况还是其他情况。没有熟练的床边助手的机器人外科医生应该考虑自行抽吸，就像许多腹腔镜外科医生的常规做法一样。
