Hotz Anne-Sophie, Seeger Nico, Gantner Lukas, Grieder Felix, Breitenstein Stefan
Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.
World J Surg. 2025 May;49(5):1221-1227. doi: 10.1002/wjs.12531. Epub 2025 Mar 23.
The use of surgical robots in minimally invasive visceral surgery is increasing, with new platforms like the Dexter Robotic System. This study evaluated the implementation of Dexter in a general visceral surgery department, focusing on safety, performance, and surgeon stress in elective cholecystectomy.
Three surgeons with varying laparoscopic and robotic experience performed robotic cholecystectomies with Dexter between December 2022 and June 2024. Perioperative outcomes and safety data were collected until 30 days post-surgery. Surgeons' stress load and physical discomfort were assessed using validated questionnaires (SMEQ, STAI, and LED).
Fifty-nine patients underwent elective gallbladder removal. Median age was 52 years (range 27-85) and BMI 26.3 kg/m (range 18.3-41.2). All surgeries were completed robotically without conversion to open surgery. There were no intraoperative complications or device deficiencies. Two cases were converted to laparoscopy due to patient anatomy and a liver tumor discovery. One postoperative complication (Clavien-Dindo grade 3A) involved choledocholithiasis requiring ERCP. Median total operating time, docking time, and console use time were 60 min (IQR 50-78), 5 min (IQR 4-7), and 23 min (IQR 19-34), respectively. Operative times revealed a fast-learning experience, stabilizing after 10-15 cases. Surgeons reported high comfort (LED Median 3, IQR 0-6) and low stress (SMEQ median 10, IQR 10-26.25).
The Dexter system was safely implemented in clinical practice, with efficient learning curve and low perceived stress, even for surgeons without prior robotic experience. Further studies are needed to determine whether Dexter offers advantages over conventional techniques.
随着德克斯特机器人系统等新平台的出现，手术机器人在微创内脏手术中的应用正在增加。本研究评估了德克斯特机器人系统在普通内脏外科的应用情况，重点关注择期胆囊切除术中的安全性、性能和外科医生的压力。
2022年12月至2024年6月期间，三名具有不同腹腔镜和机器人手术经验的外科医生使用德克斯特机器人系统进行了机器人胆囊切除术。收集围手术期结果和安全数据直至术后30天。使用经过验证的问卷（SMEQ、STAI和LED）评估外科医生的压力负荷和身体不适情况。
59例患者接受了择期胆囊切除术。中位年龄为52岁（范围27 - 85岁），体重指数为26.3kg/m²（范围18.3 - 41.2）。所有手术均通过机器人完成，未转为开放手术。术中无并发症或设备缺陷。由于患者解剖结构和发现肝脏肿瘤，有2例转为腹腔镜手术。1例术后并发症（Clavien-Dindo 3A级）为胆总管结石，需要进行内镜逆行胰胆管造影（ERCP）。中位总手术时间、对接时间和控制台使用时间分别为60分钟（四分位间距50 - 78）、5分钟（四分位间距4 - 7）和23分钟（四分位间距19 - 34）。手术时间显示出快速学习的过程，在10 - 15例手术后趋于稳定。外科医生报告舒适度高（LED中位数为3，四分位间距0 - 6），压力低（SMEQ中位数为10，四分位间距10 - 26.25）。
德克斯特系统在临床实践中安全实施，具有高效的学习曲线和较低的感知压力，即使对于没有机器人手术经验的外科医生也是如此。需要进一步研究以确定德克斯特系统是否比传统技术具有优势。
