机器人与腹腔镜腹股沟疝修补术中的游离能量损伤：一项随机对照试验。
Stray energy injury during robotic versus laparoscopic inguinal hernia repair: a randomized controlled trial.
机构信息
Department of Surgery, The University of Colorado School of Medicine & The Denver Veterans Affairs Medical Center, Aurora, CO, USA.
Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
出版信息
Surg Endosc. 2023 Nov;37(11):8771-8777. doi: 10.1007/s00464-023-10331-3. Epub 2023 Aug 14.
BACKGROUND
Stray energy transfer from monopolar instruments during laparoscopic surgery is a recognized cause of potentially catastrophic complications. There are limited data on stray energy injuries in robotic surgery. We sought to characterize stray energy injury in the form of superficial burns to the skin surrounding laparoscopic and robotic trocar sites. Our hypothesis was that stray energy burns will occur at all laparoscopic and robotic port sites.
METHODS
We conducted a prospective, randomized controlled trial of patients undergoing elective unilateral inguinal hernia repair at a VAMC over a 4-year period. Surgery was performed via transabdominal preperitoneal approach either laparoscopic-assisted (TAPP) or robotic-assisted (rTAPP). A monopolar scissor was used to deliver energy at 30W coagulation for all cases. At completion of the procedure, skin biopsies were taken from all the port sites. A picro-Sirius red stain was utilized to identify thermal injury by a blinded pathologist.
RESULTS
Over half (54%, 59/108) of all samples demonstrated thermal injury to the skin. In the laparoscopic group, 49% (25/51) samples showed thermal injury vs. 60% (34/57) in the robotic group (p = 0.548). The camera port was the most frequently involved with 68% (13/19) rTAPP samples showing injury vs. 47% (8/17) in the TAPP group (p = 0.503). There was no difference in the rate of injury at the working port site (rTAPP 53%, 10/19 vs. TAPP 47%, 8/17; p = 0.991) or the assistant port site (rTAPP 58%, 11/19 vs. TAPP 53%, 9/17; p = 0.873).
CONCLUSIONS
Stray energy causes thermal injury to the skin at port sites in the majority robotic laparoscopic TAPP inguinal hernia repairs. There is no difference in stray energy transfer between the laparoscopic and robotic platform. This is the first study to confirm in-vivo transfer of stray energy during robotic surgical procedures. More study is needed to determine the clinical significance of these thermal injuries.
背景
在腹腔镜手术中，来自单极器械的杂散能量转移是潜在灾难性并发症的公认原因。关于机器人手术中的杂散能量损伤，数据有限。我们旨在描述腹腔镜和机器人套管部位周围皮肤的浅表烧伤形式的杂散能量损伤。我们的假设是，杂散能量烧伤将发生在所有腹腔镜和机器人端口部位。
方法
我们在一家退伍军人事务医疗中心进行了一项为期 4 年的前瞻性、随机对照试验，纳入了接受单侧腹股沟疝修补术的择期患者。手术采用经腹腹膜前入路，腹腔镜辅助（TAPP）或机器人辅助（rTAPP）。所有病例均使用单极剪刀以 30W 凝血模式传递能量。手术完成后，从所有套管部位取皮肤活检。一位盲法病理学家使用 picrosirius 红染色来识别热损伤。
结果
超过一半（54%，59/108）的所有样本均显示皮肤热损伤。在腹腔镜组中，有 49%（25/51）的样本显示热损伤，而机器人组为 60%（34/57）（p=0.548）。摄像端口最常受累，有 68%（13/19）的 rTAPP 样本显示损伤，而 TAPP 组为 47%（8/17）（p=0.503）。工作端口部位（rTAPP 53%，10/19 比 TAPP 47%，8/17；p=0.991）或辅助端口部位（rTAPP 58%，11/19 比 TAPP 53%，9/17；p=0.873）的损伤发生率无差异。
结论
在大多数机器人腹腔镜经 TAPP 腹股沟疝修补术中，杂散能量会导致套管部位的皮肤热损伤。腹腔镜和机器人平台之间不存在杂散能量转移的差异。这是第一项证实机器人手术过程中杂散能量转移的体内研究。需要进一步研究来确定这些热损伤的临床意义。
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