Chen Aiqin, Yuan Ze, Chen Hanyan, Wang Xuehui, Li Huan, Zhang Xinyue
Sun Yat-sen University Cancer Center, Sate Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Sun Yat-sen Medical College, Sun Yat-sen University, Guangzhou, China.
Gland Surg. 2023 Apr 28;12(4):487-491. doi: 10.21037/gs-23-111.
In recent years, the use of robotic-assisted surgery has developed rapidly in China and is now widely used in many clinical fields. However, da Vinci robotic surgical instruments are more precise, expensive, and complex than ordinary laparoscopes, have less instrument configuration, involve restrictions on the duration of use, and have cleanliness requirements for supporting instruments. The purpose of this study was to analyze and summarize the current status of cleaning, disinfection, and maintenance of da Vinci robotic surgical instruments in China to improve the management of these devices.
A questionnaire survey on the use of da Vinci robotic-assisted surgery at medical institutions in China was designed, distributed, and analyzed. The survey included items regarding general information, management of instrument handling personnel, instrument handling techniques, guidelines, and references for instrument handling. The results and conclusions were formed from the data generated by the analysis system and the answers of respondents to the open-ended questions.
(I) All surgical instruments used in domestic surgery practice were imported. There were 25 hospitals that conduct more than 500 da Vinci robotic-assisted surgeries every year. (II) In a relatively high proportion of medical institutions, nurses continued to be responsible for the processes of cleaning (46%), disinfection (66%), and low-temperature sterilization (50%). (III) A total of 62% of the surveyed institutions used fully manual methods for cleaning instruments, and 30% of the ultrasonic cleaning equipment in surveyed institutions did not comply with the standard. (IV) A total of 28% of surveyed institutions used only visual inspection to evaluate cleaning efficacy. Only 16-32% of surveyed institutions regularly used adenosine triphosphate (ATP), residual protein, and other methods to detect sterilization of cavities in instruments. (V) In 60% of the surveyed institutions, robotic surgical instruments have been damaged.
Cleaning efficacy detection methods of robotic surgical instruments were not uniform and standardized. The management of device protection operations should be further regulated. In addition, further study of relevant guidelines and specifications as well as the training of operators is warranted.
近年来，机器人辅助手术在中国发展迅速，目前已广泛应用于许多临床领域。然而，达芬奇机器人手术器械比普通腹腔镜更精确、昂贵且复杂，器械配置较少，使用时间有限制，对配套器械有清洁要求。本研究旨在分析和总结中国达芬奇机器人手术器械的清洗、消毒和维护现状，以改善这些设备的管理。
设计、发放并分析了一份关于中国医疗机构使用达芬奇机器人辅助手术的问卷调查。该调查包括一般信息、器械处理人员管理、器械处理技术、指南以及器械处理参考等项目。结果和结论由分析系统生成的数据以及受访者对开放式问题的回答形成。
（I）国内手术实践中使用的所有手术器械均为进口。每年进行超过500例达芬奇机器人辅助手术的医院有25家。（II）在较高比例的医疗机构中，护士继续负责清洗（46%）、消毒（66%）和低温灭菌（50%）过程。（III）共有62%的受调查机构使用完全手动的方法清洁器械，受调查机构中30%的超声清洗设备不符合标准。（IV）共有28%的受调查机构仅通过目视检查评估清洗效果。只有16 - 32%的受调查机构定期使用三磷酸腺苷（ATP）、残留蛋白等方法检测器械腔隙的灭菌情况。（V）在60%的受调查机构中，机器人手术器械出现过损坏。
机器人手术器械的清洗效果检测方法不统一、不规范。应进一步规范设备保护操作的管理。此外，有必要进一步研究相关指南和规范以及对操作人员进行培训。
