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目的评估机器人(达芬奇系统)辅助胸腔镜解剖性肺切除手术的有效性、安全性及可行性,总结机器人手术的学习曲线。方法回顾性分析2016年3~6月,我科机器人辅助胸腔镜解剖性肺切除手术40例患者的临床资料,男29例、女11例,年龄54~78(60.2±12.7)岁;与同期行常规胸腔镜手术的37例患者[男27例、女10例,年龄52~76(58.7±11.5)岁]进行对比,分析其手术时间、术中出血量、胸腔引流时间、术后住院时间、围手术期并发症发生率及死亡率,评估其安全性及可行性,同时总结机器人手术的学习曲线。结果两组患者手术时间、术后呼吸机辅助时间、术中出血量、胸腔引流时间和术后疼痛,术后平均住院日,术后并发症发生率差异均无统计学意义。机器人辅助组术前准备时间长于胸腔镜组(24.5 min vs.15.6 min,P=0.003),机器人辅助组术中中转率低于胸腔镜组(0 vs.10.8%),两组均无围手术期死亡。结论机器人辅助胸腔镜解剖性肺切除手术在前期学习过程中安全有效,初始10例手术过后,学习曲线即可从学习阶段进入到标准阶段。
Objective To evaluate the effectiveness, safety and feasibility of robotic (Da Vinci system) assisted thoracoscopic anatomic pneumonectomy and to summarize the learning curve of robotic surgery. Methods The clinical data of 40 patients with robotic assisted thoracoscopic anatomy and pneumonectomy from March to June in 2016 were retrospectively analyzed. There were 29 males and 11 females, ranging in age from 54 to 78 (60.2 ± 12.7) years. In the same period, Thirty-seven patients (27 males and 10 females, aged 52-76 years (58.7 ± 11.5) years) who underwent conventional thoracoscopic surgery were analyzed. The operative time, intraoperative blood loss, chest drainage time, postoperative hospital stay , The incidence of perioperative complications and mortality, assessment of its safety and feasibility, at the same time summarize the learning curve of robot surgery. Results There was no significant difference in the operation time, postoperative ventilator support time, intraoperative blood loss, chest drainage time and postoperative pain, postoperative average length of stay, and postoperative complications. The time for preoperative preparation in robotic group was longer than that in thoracoscopic group (24.5 min vs.15.6 min, P = 0.003). The intraoperative transfer rate in robotic group was lower than that in thoracoscopic group (0 vs.10.8%), Period of death. Conclusions Robot-assisted thoracoscopic anatomic pneumonectomy is safe and effective in the early learning process. After the initial operation of 10 cases, the learning curve can enter the standard stage from the learning stage.