ロボット支援腹腔鏡下子宮全摘術の導入と周術期アウトカムの検討

抄録

Objective: Perioperative outcomes in the first year of introducing robot-assisted hysterectomy (RAH) using the daVinci Xi surgical system were evaluated based on comparisons with conventional laparoscopic hysterectomy (CLH) for simple hysterectomies performed during the same period.

Methods: This was a retrospective study involving comparisons between 38 cases of RAH from June 2019 to April 2020 and 28 cases of CLH from August 2018 to April 2020. All cases involved simple hysterectomies performed by 4 doctors (1 endoscopic technique-certified medical doctor and 3 doctors with less than 10 years of experience).

Results: The characteristics of patients who underwent RAH and CLH were as follows, respectively: age, 47 vs 49 years (mean, p=0.62); body mass index, 23.4vs 22.9 kg/m² (mean, p=0.57); uterine weight, 152 and 175 g (median, p=0.39); manipulator use, 28 (73%) and 21 (75%) cases (frequency, p=0.90); and 0/4 cases with endometriotic adhesions with Douglas fossa closure, 0 and 4 cases (frequency, p=0.028). The total operation time (from skin incision to skin closure) was significantly shorter in RAH cases (mean difference, 29 minutes; p=0.048) than in CLH cases. There was no significant difference between the two groups in terms of blood loss and perioperative complications.

Conclusion: We safely introduced RAH by selecting appropriate cases in advance. In the future, it is necessary to study robot-assisted surgery so that it can be safely introduced in patients with large uterine weights and endometriotic adhesions.