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优化机器人甲状腺手术:104 例回顾性分析的经验教训。

Optimizing robotic thyroid surgery: lessons learned from an retrospective analysis of 104 cases.

机构信息

Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China.

Clinical Research Center for Precision Management of Thyroid Cancer of Fujian Province, Fuzhou, China.

出版信息

Front Endocrinol (Lausanne). 2024 Jan 30;15:1337322. doi: 10.3389/fendo.2024.1337322. eCollection 2024.

Abstract

BACKGROUND

Robotic assistance in thyroidectomy is a developing field that promises enhanced surgical precision and improved patient outcomes. This study investigates the impact of the da Vinci Surgical System on operative efficiency, learning curve, and postoperative outcomes in thyroid surgery.

METHODS

We conducted a retrospective cohort study of 104 patients who underwent robotic thyroidectomy between March 2018 and January 2022. We evaluated the learning curve using the Cumulative Sum (CUSUM) analysis and analyzed operative times, complication rates, and postoperative recovery metrics.

RESULTS

The cohort had a mean age of 36 years, predominantly female (68.3%). The average body mass index (BMI) was within the normal range. A significant reduction in operative times was observed as the series progressed, with no permanent hypoparathyroidism or recurrent laryngeal nerve injuries reported. The learning curve plateaued after the 37th case. Postoperative recovery was consistent, with no significant difference in hospital stay duration. Complications were minimal, with a noted decrease in transient vocal cord palsy as experience with the robotic system increased.

CONCLUSION

Robotic thyroidectomy using the da Vinci system has demonstrated a significant improvement in operative efficiency without compromising safety. The learning curve is steep but manageable, and once overcome, it leads to improved surgical outcomes and high patient satisfaction. Further research with larger datasets and longer follow-up is necessary to establish the long-term benefits of robotic thyroidectomy.

摘要

背景

机器人辅助甲状腺切除术是一个正在发展的领域,有望提高手术精度并改善患者的预后。本研究旨在探讨达芬奇手术系统对甲状腺手术的手术效率、学习曲线和术后结果的影响。

方法

我们对 2018 年 3 月至 2022 年 1 月期间接受机器人甲状腺切除术的 104 例患者进行了回顾性队列研究。我们使用累积和(CUSUM)分析评估了学习曲线,并分析了手术时间、并发症发生率和术后恢复指标。

结果

该队列的平均年龄为 36 岁,主要为女性(68.3%)。平均体质量指数(BMI)在正常范围内。随着手术系列的进行,手术时间显著缩短,无永久性甲状旁腺功能减退或喉返神经损伤的报告。学习曲线在第 37 例后趋于平稳。术后恢复情况一致,住院时间无明显差异。并发症很少见,随着对机器人系统经验的增加,暂时性声带麻痹的发生率有所下降。

结论

达芬奇系统机器人甲状腺切除术在不影响安全性的情况下显著提高了手术效率。学习曲线陡峭但可管理,一旦克服,就可以提高手术效果和患者满意度。需要进一步进行更大数据集和更长随访的研究,以确立机器人甲状腺切除术的长期获益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3db3/10867960/38304246b269/fendo-15-1337322-g001.jpg

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