Campetella Marco, Ragonese Mauro, Gandi Carlo, Bizzarri Francesco Pio, Russo Pierluigi, Foschi Nazario, Bientinesi Riccardo, Sacco Emilio
Department of Urology, Ospedale Isola Tiberina, Gemelli Isola, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Urologia. 2025 Feb;92(1):161-168. doi: 10.1177/03915603241300226. Epub 2024 Nov 18.
Technological advancements have revolutionized surgical methods, with laparoscopic and robotic surgeries offering significant benefits over traditional open procedures. These benefits include reduced intraoperative blood loss, shortened hospital stays, faster recovery, and improved cosmetic outcomes. However, the learning curve for laparoscopic surgery remains a challenge. Robotic systems, like the da Vinci Surgical System, address many limitations of laparoscopic surgery, including limited range of motion and tremors, and offer superior ergonomics. Despite concerns over cost and tactile feedback, innovations like telesurgery and augmented reality are enhancing robotic surgery's potential. Moreover, robotic surgery generally results in less blood loss, fewer complications, and quicker recovery compared to open surgery. Robotic surgery tends also to be less physically demanding for surgeons, reducing fatigue and musculoskeletal strain. However, research also reveals that many surgeons still experience discomfort, particularly in the neck and shoulders, emphasizing the need for ergonomic training and improved workstation setups. The review also explores the impact of pre-procedure fatigue on surgical performance, noting that fatigue can impair performance on surgical simulators, particularly among residents. Despite this, studies showed that performing consecutive surgeries in a single day does not appear to adversely affect patient outcomes. Overall, ergonomic interventions are crucial in both laparoscopic and robotic surgeries to enhance surgeon efficiency and well-being, and further research is needed to optimize these surgical methods and understand the long-term impacts of fatigue on performance and patient outcomes.
技术进步彻底改变了手术方法，腹腔镜手术和机器人手术相较于传统开放手术具有显著优势。这些优势包括术中失血减少、住院时间缩短、恢复更快以及美容效果更佳。然而，腹腔镜手术的学习曲线仍然是一项挑战。机器人系统，如达芬奇手术系统，解决了腹腔镜手术的许多局限性，包括运动范围有限和震颤问题，并提供了更优越的人体工程学设计。尽管存在成本和触觉反馈方面的担忧，但远程手术和增强现实等创新技术正在提升机器人手术的潜力。此外，与开放手术相比，机器人手术通常导致的失血更少、并发症更少且恢复更快。机器人手术对外科医生的体力要求也往往较低，减少了疲劳和肌肉骨骼劳损。然而，研究还表明，许多外科医生仍然感到不适，尤其是颈部和肩部，这凸显了人体工程学培训和改善工作站设置的必要性。该综述还探讨了术前疲劳对手术表现的影响，指出疲劳会损害手术模拟器上的表现，尤其是住院医生。尽管如此，研究表明在一天内连续进行手术似乎不会对患者预后产生不利影响。总体而言，人体工程学干预对于腹腔镜手术和机器人手术提高外科医生效率和福祉至关重要，还需要进一步研究以优化这些手术方法，并了解疲劳对手术表现和患者预后的长期影响。
