The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Hakim Management, 7 Tourmaline Crescent, Wheelers Hill, Melbourne, VIC, 3150, Australia.
J Robot Surg. 2024 Nov 2;18(1):392. doi: 10.1007/s11701-024-02145-9.
This study aims to investigate factors influencing the implementation of robotic-assisted radical surgery, with a specific focus on their effects on blood loss and operative time. Radical prostatectomy was chosen as the case study due to its complexity and diverse surgical activities. The study employed a three-round Delphi approach involving 25 surgeons from three countries: UK, Australia, and China. The collected data were analysed using non-parametric tests. The Delphi study showed significant correlations between the degree of difficulty and blood loss (Z = 2.698, ρ < 0.007), as well as between team coordination and blood loss (Z = 3.499, ρ < 0.0001). However, no significant relationship was found between operative time and blood loss. Surgeons reported that neurovascular bundle (NVB) release and pelvic lymph node dissection require high team coordination. NVB release is particularly challenging and poses a higher risk of blood loss. Additionally, a large prostate increases the difficulty of prostate dissection, prolongs operative time for bladder neck and NVB dissection, and leads to a considerable overall increase in operative time. The manuscript shows that effective team coordination plays a crucial role in reducing blood loss and operative time during surgical activities. When the team coordinates well, clear and efficient verbal communication suffices, reducing the need for physical proximity during robotic-assisted surgeries.
本研究旨在探讨影响机器人辅助根治性手术实施的因素，特别关注其对出血量和手术时间的影响。选择根治性前列腺切除术作为案例研究，是因为其具有复杂性和多样化的手术活动。研究采用三轮德尔菲法，涉及来自英国、澳大利亚和中国的 25 名外科医生。使用非参数检验对收集的数据进行分析。德尔菲研究表明，手术难度与出血量之间（Z=2.698，ρ<0.007）以及团队协作与出血量之间（Z=3.499，ρ<0.0001）存在显著相关性。然而，手术时间与出血量之间没有显著关系。外科医生报告称，神经血管束（NVB）释放和盆腔淋巴结清扫需要高度的团队协作。NVB 释放特别具有挑战性，并且存在更高的出血风险。此外，前列腺较大增加了前列腺解剖的难度，延长了膀胱颈和 NVB 解剖的手术时间，导致总手术时间显著增加。本文表明，有效的团队协作在减少手术过程中的出血量和手术时间方面起着至关重要的作用。当团队协作良好时，清晰高效的口头沟通就足够了，这减少了机器人辅助手术中对身体接近的需求。
