Impact of Surgeon-Controlled Suction During Robotic Prostatectomy to Reduce Dependence on Bedside Assistance
Impact of Surgeon-Controlled Suction During Robotic Prostatectomy to Reduce Dependence on Bedside Assistance
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DOI：
10.1089/end.2020.1059
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发表时间：
2021-04-13
影响因子：
2.7
通讯作者：
Abaza, Ronney
中科院分区：
文献类型：
--
作者：
Martinez, Oscar;Murphy, Christopher;Abaza, Ronney
背景：机器人手术期间的抽吸传统上由床边助手执行。熟练的助手并不总是可用的。我们评估了一种专门设计的机器人外科医生控制的吸引导管的效率和安全性，通过与使用标准刚性腹腔镜吸引的专用床边助手控制的历史病例进行比较。方法：从2019年2月开始，远程操作抽吸冲洗（ROSI）设备用于所有机器人乳房切除术，其是由外科医生操纵的柔性抽吸导管，使得不需要床边助手来进行抽吸。最初的300个连续的情况下进行ROSI进行了比较，300前不久的程序，使用床边辅助抽吸（BAS）。结果：有没有统计学上的显着差异组之间的年龄，体重指数，美国麻醉医师协会评分，前列腺特异性抗原，或病理分期。所有600例患者均行淋巴结清扫术。所有300例ROSI病例均在无需切换至BAS的情况下完成。估计失血量（102.7 vs 120.2 mL，p=0.001）和手术时间（156.1 vs 149.3分钟，p= III），两组均有3%的患者在手术后90天内再次入院或在急诊科就诊。外科医生控制的抽吸允许更多的外科医生自主权，而不会对效率或需要“救助”的安全性问题产生负面影响无论是否紧急，床边助理都应进行抽吸。机器人外科医生如果没有熟练的床边助手，就应该考虑自己吸痰，这与许多腹腔镜外科医生的标准做法没有什么不同。
Background: Suction during robotic surgery has traditionally been performed by a bedside assistant. Adequately skilled assistants are not always available. We assessed a purpose-designed robotic surgeon-controlled suction catheter for efficiency and safety by comparing with historic cases of suction controlled by a dedicated bedside assistant using standard rigid laparoscopic suction.Methods: Beginning in February 2019, the remotely operated suction irrigation (ROSI) device was used in all robotic prostatectomy procedures, which is a flexible suction catheter manipulated by the surgeon such that a bedside assistant is never required for suction. The initial 300 consecutive cases performed with ROSI were compared with the 300 immediately previous procedures using bedside assistant suction (BAS).Results: There were no statistically significant differences between groups in age, body mass index, American Anesthesiologist Association score, prostate specific antigen, or pathologic stage. Lymph node dissection was performed in all 600 patients. All 300 ROSI cases were completed without requiring switching to BAS. Estimated blood loss (102.7 vs 120.2mL, p=0.001) and operative time (156.1 vs 149.3 minutes, p= III) between groups, with both having 3% of patients readmitted or seen in the emergency department within 90 days of surgery.Conclusion: Surgeon-controlled suction allowed more surgeon autonomy without a negative impact on efficiency or safety issues requiring "bailout" suctioning by the bedside assistant whether urgent or otherwise. Robotic surgeons without access to skilled bedside assistants should consider suctioning for themselves not unlike the norm for many laparoscopic surgeons.