Massias Samuel, Vadhwana Bhamini, Arjomandi Rad Arian, Hollingshead James, Patel Vanash
Department of Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital.
Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London.
Ann Med Surg (Lond). 2024 Sep 10;86(10):5744-5749. doi: 10.1097/MS9.0000000000002545. eCollection 2024 Oct.
Robotic-assisted surgery (RAS) is one of the most influential surgical advances with widespread clinical and health-economic benefits. West Hertfordshire Teaching Hospital NHS Trust was the first in the UK to simultaneously integrate two CMR Surgical Versius robots. This study aims to investigate clinical outcomes of RAS, explore surgeon learning curves and assess the feasibility of implementation within a district general hospital (DGH).
A prospective cohort study of 100 consecutive patient data were collected between July 2022 and August 2023, including demographics, operative and clinical variables, and compared with laparoscopic surgery (LS) data from the National Bowel Cancer Audit. Surgeon learning curves were analysed using sequential surgical and console times.
In the RAS cohort, the median age was 70 (IQR 57-78 years) and 60% were male. Retrieval of a minimum of 12 lymph nodes significantly increased in RAS compared to LS (95% vs. 88%, =0.05). The negative mesorectal margin rate was similar between RAS and LS (97% vs. 91%, =0.10), as well as length of stay greater than 5 days (42% vs. 39%, =0.27). For anterior resections performed by the highest volume surgeon (=16), surgical time was reduced over 1 year by 35% (304.9-196.9 min), whilst console time increased by 111% (63.0-132.8 min).
Key quality performance indicators were either unchanged or improved with RAS. There is potential for improved theatre utilisation and cost-savings with increased RAS. This study demonstrates the feasibility and easy integration of robotic platforms into DGHs, offering wider training opportunities for the next generation of surgeons.
机器人辅助手术（RAS）是最具影响力的外科进展之一，具有广泛的临床和健康经济效益。西赫特福德郡教学医院国民保健服务信托基金是英国第一家同时整合两台CMR Surgical Versius机器人的医院。本研究旨在调查RAS的临床结果，探索外科医生的学习曲线，并评估在地区综合医院（DGH）实施的可行性。
对2022年7月至2023年8月期间连续收集的100例患者数据进行前瞻性队列研究，包括人口统计学、手术和临床变量，并与国家肠癌审计的腹腔镜手术（LS）数据进行比较。使用连续手术时间和控制台时间分析外科医生的学习曲线。
在RAS队列中，中位年龄为70岁（四分位间距57 - 78岁），60%为男性。与LS相比，RAS中至少获取12个淋巴结的比例显著增加（95%对88%，P = 0.05）。RAS和LS之间的直肠系膜切缘阴性率相似（97%对91%，P = 0.10），住院时间大于5天的比例也相似（42%对39%，P = 0.27）。对于手术量最高的外科医生（n = 16）进行的前切除术，手术时间在1年内减少了35%（304.9 - 196.9分钟），而控制台时间增加了111%（63.0 - 132.8分钟）。
RAS的关键质量绩效指标要么保持不变，要么有所改善。随着RAS的增加，手术室利用率有提高和节省成本的潜力。本研究证明了将机器人平台整合到DGH中的可行性和易操作性，为下一代外科医生提供了更广泛的培训机会。
