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心脏外科手术中的机器人革命。

The robotic revolution in cardiac surgery.

作者信息

Wah Jack Ng Kok

机构信息

Multimedia University, Cyberjaya, Malaysia.

Persiaran Multimedia, 63100, Cyberjaya, Selangor, Malaysia.

出版信息

J Robot Surg. 2025 Jul 13;19(1):386. doi: 10.1007/s11701-025-02535-7.

Abstract

Robotic-assisted cardiac surgery (RACS) is revolutionizing the landscape of cardiovascular interventions through technological precision, minimally invasive techniques, and improved clinical outcomes. Despite its rapid expansion, significant gaps remain regarding standardization, cost-efficiency, surgeon learning curves, and patient-centered outcomes. The study critically examines current innovations, evaluates comparative clinical and economic impacts, and synthesizes key trends and contradictions from 26 recent studies. The objective is to assess the clinical efficacy, scalability, and systemic implications of RACS across diverse procedures, such as mitral valve repair, coronary artery bypass grafting, and emerging robotic heart and congenital surgeries. Employing a mixed-methods approach, including qualitative analysis of patient experiences and quantitative evaluation of national databases and long-term outcomes, the review integrates systematic reviews, case studies, and meta-analyses for a comprehensive comparative synthesis. Findings highlight superior perioperative outcomes, faster recovery, and reduced complication rates in RACS compared to the conventional surgery. Robotic proficiency correlates strongly with surgical volume, institutional infrastructure, and interdisciplinary training, while economic evaluations remain mixed, indicating higher upfront costs but potential long-term savings. Notably, patient satisfaction is consistently high due to reduced invasiveness and faster rehabilitation yet concerns about accessibility and healthcare equity persist. Contradictory evidence surrounds the cost-benefit balance in low-volume centers and the influence of patient complexity on the learning curve, although emerging evidence suggests that these factors are becoming less prohibitive with experience and technological refinement. The review identifies gaps in multicenter longitudinal studies, standard training frameworks, and integration of Internet of Robotic Things (IoRT) in clinical workflows. It recommends expanding global data-sharing platforms, refining robotic surgical curricula, and enhancing AI-driven support systems for precision guidance. The implications span patient care quality, surgical education, healthcare economics, and future robotic innovations. Limitations include potential publication bias and underrepresentation of low-resource settings. Future research should focus on longitudinal, multicentric trials evaluating robotic outcomes across different demographics, procedures, and healthcare infrastructures. In conclusion, the robotic revolution in cardiac surgery promises transformative advances, yet requires coordinated global efforts to bridge disparities, optimize training, and validate its long-term value in complex cardiovascular care.

摘要

机器人辅助心脏手术(RACS)正在通过技术精准度、微创技术和改善临床结果彻底改变心血管介入治疗的格局。尽管其迅速发展,但在标准化、成本效益、外科医生学习曲线和以患者为中心的结果方面仍存在重大差距。该研究批判性地审视了当前的创新成果,评估了比较临床和经济影响,并综合了26项近期研究的关键趋势和矛盾之处。目的是评估RACS在各种手术中的临床疗效、可扩展性和系统影响,如二尖瓣修复、冠状动脉搭桥术以及新兴的机器人心脏和先天性心脏病手术。采用混合方法,包括对患者体验的定性分析以及对国家数据库和长期结果的定量评估,该综述整合了系统评价、案例研究和荟萃分析以进行全面的比较综合。研究结果突出显示,与传统手术相比,RACS在围手术期结果方面更优,恢复更快,并发症发生率更低。机器人操作熟练程度与手术量、机构基础设施和跨学科培训密切相关,而经济评估结果不一,表明前期成本较高,但可能有长期节省。值得注意的是,由于侵入性降低和康复更快,患者满意度一直很高,但对可及性和医疗公平性的担忧仍然存在。关于低手术量中心的成本效益平衡以及患者复杂性对学习曲线的影响存在相互矛盾的证据,尽管新出现的证据表明,随着经验积累和技术改进,这些因素的限制作用正在减弱。该综述指出了多中心纵向研究、标准培训框架以及机器人物联网(IoRT)在临床工作流程中的整合方面的差距。它建议扩大全球数据共享平台,完善机器人手术课程,并加强人工智能驱动的精准指导支持系统。其影响涉及患者护理质量、外科教育、医疗经济学和未来机器人创新。局限性包括潜在的发表偏倚和低资源环境代表性不足。未来的研究应侧重于纵向、多中心试验,评估机器人手术在不同人口统计学、手术和医疗基础设施中的结果。总之,心脏手术中的机器人革命有望带来变革性进展,但需要全球协调努力,以弥合差距、优化培训并验证其在复杂心血管护理中的长期价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c9a7/12256362/857e6af79a44/11701_2025_2535_Fig1_HTML.jpg

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