Yoshimura Takuma, Nishio Hiroshi, Sakai Kensuke, Nogami Yuya, Hayashi Shigenori, Yamagami Wataru
Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan.
Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, Kawasaki-shi, Kanagawa, Japan.
Gynecol Minim Invasive Ther. 2024 Dec 27;14(1):33-39. doi: 10.4103/gmit.gmit_144_23. eCollection 2025 Jan-Mar.
The initial learning curve is a barrier to introducing robotic surgery. Evidence regarding appropriate simulation programs that allow for a smooth introduction of gynecological robotic surgery remains limited.
We retrospectively analyzed 149 patients who underwent robotic surgery for gynecologic diseases. Before their first procedure, the surgeons completed a robotic surgery training program. Assistant surgeons also completed simulation programs, including setup procedures and manipulation of the robotic arm.
The mean (± standard deviation) operative, setup, and console times were 170 ± 54 min, 22 ± 8 min, and 126 ± 51 min, respectively. No patient required blood transfusion or conversion to laparoscopy or laparotomy. Patients undergoing surgery by the same surgeon were divided into three groups (first-third, middle-third, and last-third of patients undergoing surgery) to assess chronological changes. No statistically significant differences were found between the operative and console times among these groups. The setup times for the middle and last third of patients were 20 ± 7 min and 18 ± 7 min, respectively, which were statistically significantly shorter than those for the first third of patients. No significant differences in the operative and console times done by five physicians who completed programs were observed between the first 75 and the latter 74 procedures; however, the setup times of the latter 74 procedures were significantly shorter than those of the first 74 procedures (25 ± 9 min vs. 19 ± 6 min; < 0.001).
The setup time was influenced by clinical experience. An appropriate simulation program allowed a safe implementation of robotic surgery.
初始学习曲线是引入机器人手术的一个障碍。关于能顺利引入妇科机器人手术的合适模拟程序的证据仍然有限。
我们回顾性分析了149例因妇科疾病接受机器人手术的患者。在他们的首次手术前，外科医生完成了一个机器人手术培训项目。助理外科医生也完成了模拟程序，包括机器人手臂的设置程序和操作。
平均（±标准差）手术时间、设置时间和控制台操作时间分别为170±54分钟、22±8分钟和126±51分钟。没有患者需要输血或转为腹腔镜手术或开腹手术。将由同一位外科医生进行手术的患者分为三组（接受手术患者的前三分之一、中间三分之一和后三分之一）以评估时间上的变化。这些组之间的手术时间和控制台操作时间没有发现统计学上的显著差异。中间三分之一和后三分之一患者的设置时间分别为20±7分钟和18±7分钟，在统计学上显著短于前三分之一患者的设置时间。在完成项目的五位医生进行的前75例手术和后74例手术之间，未观察到手术时间和控制台操作时间有显著差异；然而，后74例手术的设置时间显著短于前74例手术（25±9分钟对19±6分钟；<0.001）。
设置时间受临床经验影响。一个合适的模拟程序能使机器人手术安全实施。
