ダブルバイポーラ法を用いた３アーム２インストゥルメントRSC

抄録

Objective: Our department introduced robot-assisted sacrocolpopexy (RSC) for pelvic organ prolapse in December 2022. Initially, RSC was performed with four arms and one assistant port (4a-RSC), but we modified this to three-arm RSC (3a3i-RSC) without the third arm to reduce interference between the arms. Later, we introduced the double bipolar method and remodified the system to a three-arm, two instrument RSC (3a2i-RSC). We reviewed the surgical outcomes of each modification of the RSC.

Methods: We retrospectively evaluated the records of 30 women who underwent RSC by the same surgeon at our hospital between December 2022 and October 2024, divided into three groups: 4a-RSC (3 cases), 3a3i-RSC (11 cases), and 3a2i-RSC (16 cases). The records were statistically analyzed for patient age, number of trimesters, BMI, operative time, console time, specimen weight, and blood loss. Costs were also compared between groups.

Results: Operative and console times were significantly shorter in the 3a2i RSC group than in the other two groups (operative time: 4a-RSC 348 min vs 3a3i-RSC 300 min vs 3a2i-RSC 215 min; console time: 234 min vs 192 min vs 149 min). In addition, the cost of 3a2i-RSC was reduced by approximately 82,000 yen compared to 4a-RSC.

Conclusion: The three-arm, two-instrument RSC had the advantages of improved cosmetics and reduced costs by reducing the number of arms and instruments used, as well as preventing potential errors associated with instrument replacement. In addition, it did not prolong operative time or increase blood loss, and the quality of the operation seemed to have been maintained.