ロボット支援腹腔鏡下単純子宮全摘術における３アーム/４ポート手術の有用性の検討

抄録

Introduction: Previously, robotic-assisted laparoscopic total hysterectomy at our institution utilized three arms/four ports (one camera arm, two operating arms, and one assist port). To enhance efficiency, we transitioned to using four arms/five ports (one camera arm, three operating arms, and one assist port) in April 2023. This study aimed to assess the effect of the number of robotic arms on surgical outcomes.

Methods: We analyzed cases of robotic-assisted laparoscopic total hysterectomy procedures performed between July 2020 and February 2024, comparing patient data and surgical outcomes between the three-arm and four-arm groups.

Results: The study included 110 three-arm and 47 four-arm cases. No significant differences were observed in age, BMI, or uterine weight between the groups. However, the three-arm group exhibited a significantly higher manipulator utilization rate (p < 0.01). Compared to the four-arm group, the three-arm group showed significantly shorter times for console setup, console completion, and total surgery (all p < 0.01). No significant differences were observed in the time from console completion to surgical completion time. Multiple regression analysis indicated that lower BMI and the usage of the three-arm intervention were associated with shorter console setup times, whereas lower uterine weight along with the three-arm intervention, were associated with shorter console and surgical times (all p < 0.01).

Discussion: Robotic-assisted laparoscopic total hysterectomy with three arms was found to be as efficient as that with four arms, potentially offering economic benefits through reduced instrument usage.