Hope William W, Bittner James G, Pullatt Rana C, Newcomb William L, Erbella Jose, Thies Steven D, Verdeja Juan-Carlos
Department of Surgery, New Hanover Regional Medical Center, 2131 South 17th Street, Wilmington, NC, 28401, USA.
Department of Surgery, University of Connecticut School of Medicine, Hartford, CT, USA.
Hernia. 2025 Jan 6;29(1):63. doi: 10.1007/s10029-024-03218-2.
Available reports of surgeon efficiency when transitioning from laparoscopic to robotic-assisted (RA) inguinal hernia repair (IHR) are retrospective or describe single-center experience. The purpose of this study is to provide a prospective, multi-surgeon, multi-center assessment of surgeon efficiency when transitioning from Lap-IHR to RA-IHR.
General surgeons with Lap-IHR experience (≥300 Lap-IHRs prior to the study) but with no robotic experience (no RA cases one year prior to the study) consented to participate in this prospective, observational pilot study of their surgical efficiency as they adopted RA-IHR. Efficiency was measured through procedure durations, including skin-to-skin time and time to establish critical view of the myopectineal orifice (MPO). Rates of conversions, and adverse events (AEs) through 30 days post RA-IHR procedure were also reported. Outcomes with 95% confidence intervals (95% CI) describe surgeons' collective and individual unilateral and bilateral early, middle, and late-phase cases, with each surgeon contributing 25 consecutive cases at each phase.
Four surgeons consented to enroll in the study and provided 75 consecutive, prospective RA-IHR cases. Collectively, the surgeons reached relative skin-to-skin time efficiencies for their unilateral repairs in the mid-phase of their prospective cases. For RA-IHR bilateral procedures, skin-to-skin time efficiency was reached in the late-phase cases. Surgeons' skin-to-skin efficiency times varied relative to their retrospective Lap-IHRs. Possible confounders included practice patterns, referrals, proctoring periods, and-for one surgeon-Covid interruptions. One conversion from RA-IHR to open resulted from severe adhesions present after prior prostatectomy. AEs varied broadly from surgeon to surgeon.
The four surgeons improved their skin-to-skin efficiencies.
关于外科医生从腹腔镜腹股沟疝修补术（Lap - IHR）过渡到机器人辅助（RA）腹股沟疝修补术（IHR）时的效率的现有报告多为回顾性研究，或描述的是单中心经验。本研究的目的是对外科医生从Lap - IHR过渡到RA - IHR时的效率进行前瞻性、多外科医生、多中心评估。
有Lap - IHR经验（研究前≥300例Lap - IHR）但无机器人手术经验（研究前一年无RA病例）的普通外科医生同意参与这项前瞻性观察性试点研究，以评估他们采用RA - IHR时的手术效率。通过手术时长来衡量效率，包括皮肤到皮肤的时间以及建立耻骨肌孔（MPO）关键视野的时间。还报告了RA - IHR手术后30天内的中转率和不良事件（AE）。具有95%置信区间（95%CI）的结果描述了外科医生集体和个体的单侧和双侧早期、中期和晚期病例，每个外科医生在每个阶段贡献25例连续病例。
四名外科医生同意参加该研究，并提供了7５例连续的前瞻性RA - IHR病例。总体而言，外科医生在其前瞻性病例的中期达到了单侧修复的相对皮肤到皮肤时间效率。对于RA - IHR双侧手术，在晚期病例中达到了皮肤到皮肤时间效率。外科医生的皮肤到皮肤效率时间相对于他们回顾性的Lap - IHR有所不同。可能的混杂因素包括手术模式、转诊、指导期以及——对于一名外科医生来说——新冠疫情造成的中断。1例从RA - IHR转为开放手术是由于先前前列腺切除术后出现严重粘连。不同外科医生的AE差异很大。
这四名外科医生提高了他们的皮肤到皮肤效率。
