Zhang L, Wang X X, Wang X Q, Zhang Q Y, Zhang L H, Huang Y, Lu Y
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Fu Chan Ke Za Zhi. 2025 Mar 25;60(3):183-192. doi: 10.3760/cma.j.cn112141-20241214-00670.
To describe the safety of using the Chinese-made robotic laparoscopic surgery system for laparoscopic sacrocolpopexy in the treatment of severe pelvic organ prolapse. A pilot descriptive clinical study was conducted, enrolling 16 severe pelvic organ prolapse patients at Peking University First Hospital from April 2023 to January 2024. Patients who consented to participate in this study underwent laparoscopic sacrocolpopexy for severe pelvic organ prolapse using Chinese-made robotic laparoscopic surgery system. Preoperative clinical basic data and perioperative data of the patients were collected, summarizing the data on perioperative bleeding and complications, and reviewed the surgical learning experience. The evaluation indicators related to the learning experience included: (1) efficiency evaluation: including equipment docking time, total surgery time, suturing time, mechanical arm operation time and hysterectomy time, which were timed and recorded during surgery; (2) equipment operability evaluation: including equipment operation task load assessment and intraoperative operation feeling score. The cumulative sum analysis method was used to quantify surgery time and fit the learning curve. Sixteen patients were successfully enrolled and underwent surgery, including total hysterectomy with bilateral salpingo-oophorectomy or salpingectomy plus sacrocolpopexy, or sacrocolpopexy alone (for one case without uterus). The age of 16 cases was (56.7±7.6) years (ranged from 44 to 67 years), with body mass index of (25.4±2.5) kg/m². Concurrent procedures included anterior vaginal wall repair in 12 cases (12/16), posterior vaginal wall repair in 13 cases (13/16), tension-free vaginal tape obturator system in 1 case (1/16), and recto-uterine pouch hernia repair in 4 cases (4/16). The total surgery time was (355.8±91.1) minutes, with docking time at (6.7±4.9) minutes, robotic operative time at (267.6±81.4) minutes, robotic suturing time at (155.6±53.9) minutes, and hysterectomy time at (112.0±45.3) minutes. Learning curve analysis revealed inflection points at 6 cases for total surgery time (<0.001, ²=0.944) and robotic operative time (<0.001, ²=0.982), 5 cases for docking time (<0.001, ²=0.989), and 6 cases for robotic suturing time (<0.001, ²=0.907). Hysterectomy time had an inflection point at 5 cases (=0.023, ²=0.700). Median blood loss was 30 ml (range: 10-1 000 ml), with severe bleeding in one patient (1/16). No conversions to open surgery or laparoscopy occurred, and no severe perioperative or postoperative complications were reported. The Chinese-made robotic laparoscopic surgery system demonstrates excellent short-time safety and ease of operation for laparoscopic sacrocolpopexy.
描述国产机器人腹腔镜手术系统用于腹腔镜骶骨阴道固定术治疗严重盆腔器官脱垂的安全性。进行了一项初步描述性临床研究,于2023年4月至2024年1月在北京大学第一医院招募了16例严重盆腔器官脱垂患者。同意参与本研究的患者使用国产机器人腹腔镜手术系统接受腹腔镜骶骨阴道固定术治疗严重盆腔器官脱垂。收集患者术前临床基础数据和围手术期数据,汇总围手术期出血和并发症数据,并回顾手术学习经验。与学习经验相关的评估指标包括:(1)效率评估:包括设备对接时间、总手术时间、缝合时间、机械臂操作时间和子宫切除时间,手术过程中进行计时记录;(2)设备可操作性评估:包括设备操作任务负荷评估和术中操作感受评分。采用累积和分析方法量化手术时间并拟合学习曲线。16例患者成功入组并接受手术,包括全子宫切除加双侧输卵管卵巢切除术或输卵管切除术加骶骨阴道固定术,或单纯骶骨阴道固定术(1例无子宫)。16例患者年龄为(56.7±7.6)岁(44至67岁),体重指数为(25.4±2.5)kg/m²。同期手术包括12例(12/16)阴道前壁修补术、13例(13/16)阴道后壁修补术、1例(1/16)无张力阴道吊带闭孔系统手术、4例(4/16)直肠子宫陷凹疝修补术。总手术时间为(355.8±91.1)分钟,对接时间为(6.7±4.9)分钟,机器人手术时间为(267.6±81.4)分钟,机器人缝合时间为(155.6±53.9)分钟,子宫切除时间为(112.0±45.3)分钟。学习曲线分析显示,总手术时间(<0.001,²=0.944)和机器人手术时间(<0.001,²=0.982)在6例时出现拐点,对接时间(<0.001,²=0.989)在5例时出现拐点,机器人缝合时间(<0.001,²=0.907)在6例时出现拐点。子宫切除时间在5例时出现拐点(=0.023,²=0.700)。中位失血量为30 ml(范围:10至1000 ml),1例患者(1/16)发生严重出血。未发生转为开放手术或腹腔镜手术的情况,未报告严重的围手术期或术后并发症。国产机器人腹腔镜手术系统在腹腔镜骶骨阴道固定术中显示出良好的短期安全性和操作便利性。