扶镜机器人在经胸乳径路甲状腺良性疾病手术中的应用
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作者单位:

蚌埠医学院第二附属医院 普通外科,安徽 蚌埠 233000

作者简介:

褚亮,蚌埠医学院第二附属医院副主任医师,主要从事甲状腺外科方面的研究。

基金项目:

安徽省高校协同创新基金资助项目(GXXT-2019-014)。


Application of robotic scope holder in breast approach endoscopic thyroidectomy for benign thyroid diseases
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Department of General Surgery, the Second Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233000, China

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    摘要:

    背景与目的 扶镜机器人是一种机器人辅助镜头支架,手术者可通过操纵杆控制腔镜镜头,提供精确的,稳定的手术视野,同时可以减少1名手术者,非常有利于腔镜甲状腺手术这种空间狭小,操作精细的手术。本研究探讨扶镜机器人在腔镜经胸乳径路甲状腺手术中的应用效果。方法 回顾性分析蚌埠医学院第二附属医院普外科2019年1月—2020年12月间80例接受经胸乳径路甲状腺手术的甲状腺良性疾病患者临床资料。其中42例采用机器人扶镜(观察组),38例采用人工扶镜(对照组),比较两组患者的临床指标和实施两组手术的同一组主刀医生主观感受。结果 两组患者在年龄、性别、BMI、肿瘤直径、手术方式、病理等一般资料均无明显差异(均P>0.05)。两组患者手术均顺利完成,无中转开放手术,无机器人转为人工扶镜。观察组较对照组手术时间明显缩短(P<0.05)。两组在术中出血量、术后引流量、引流时间、术后住院天数、住院费用和手术并发症发生率方面差异均无统计学意义(均P>0.05)。两组患者均无严重术后并发症发生。手术医生主观感受问卷调查结果显示,在视野精准度和视野稳定性方面以及术中操作感方面观察组明显高于对照组(均P<0.05),在视觉疲劳度方面两组之间无统计学意义(P>0.05)。结论 使用扶镜机器人在甲状腺良性疾病手术中是安全可行的,与人工扶镜相比,术中操作复杂程度有所增加,但减少了手术人员,缩短了手术时间,为手术者提供了更准确、更稳定的视野,提高了手术效率。

    Abstract:

    Background and Aims The robotic scope holder is a robot-assisted camera holding system, by which, the surgeon can control the scope movement via a joystick, and a precise and stable surgical field of vision can be secured, and meanwhile, one participating surgeon will be spared. So, it is very suitable for meticulous operation in a narrow space such as endoscopic thyroid surgery. Therefore, this study was conducted to investigate the application efficacy of the robotic scope holder in endoscopic transthoracic thyroid surgery.Methods The clinical data of 80 patients with benign thyroid disease undergoing endoscopic transthoracic thyroid surgery from January 2019 to December 2020 in the Department of General Surgery, the Second Affiliated Hospital, Bengbu Medical College were retrospectively analyzed. Of the patients, the scope was held by robotic scope holder in 42 cases (observation group) and was held by the second surgeon in 38 cases (control group). The main clinical variables between the two groups of patients and the subjective perception of the same team of operating surgeons who performed the operations of the two groups were compared.Results There were no significant differences in general data such as age, sex, BMI, tumor diameter, surgical approach and pathology between the two groups of patients (all P>0.05). The operations were successfully completed in all patients, without conversion to open surgery, and conversion from robotic to manual holding. The operative time in observation group was significantly shorter than that in control group (P<0.05). There were no significant differences in the intraoperative blood loss, volume of postoperative drainage, drainage time, length of postoperative hospital stay, hospitalization cost and incidence of complications between the two groups (all P>0.05). No serious postoperative complications were noted in both groups of patients. Questionnaire survey on the subjective perception of the operating surgeons showed that observation group was significantly superior to control group in terms of visual field accuracy and visual field stability, as well as the sense of operation during surgery (all P<0.05), while there was no statistical significance with regard to visual fatigue between the two groups (P>0.05).Conclusion The application of robotic scope holder is safe and feasible in the operation for benign thyroid diseases. Compared with manual holding, the complexity of intraoperative procedures is relatively increased, but the number of participating surgeons is reduced, the operative time is shortened. It can provide a more accurate and stable surgical vision for surgeon and thereby improve the surgical efficiency.

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褚亮,周少波,蒋磊,王法宝,曹登义.扶镜机器人在经胸乳径路甲状腺良性疾病手术中的应用[J].中国普通外科杂志,2021,30(9):1079-1085.
DOI:10.7659/j. issn.1005-6947.2021.09.011

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  • 收稿日期:2021-05-11
  • 最后修改日期:2021-07-08
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  • 在线发布日期: 2021-10-09