摘要
目的探讨如何避免机器人辅助下前列腺癌根治术中2号臂与3号臂之间的干扰现象。方法针对初学者在完成机器人辅助下前列腺癌根治术中2号臂与3号臂之间容易出现"打架"的现象,应用分区理念进行改进。将机器人前列腺癌根治术分为13个标准步骤,利用上下分区的理念,对每个步骤中2号臂与3号臂的相对位置进行限制,即在完成该步骤时2号臂和3号臂分别固定于某个区域,不得相互跨越,以防止彼此的干扰。对本科室4个机器人手术组中的6名主治医生进行分组,其中3名接受分区理念的培训,另3名不接受培训者作为对照。记录术中出现2号臂与3号臂彼此"打架"的次数。结果接受分区理念培训的3名主治医生累计共完成37个标准步骤的操作,出现机械臂"打架"的次数为8次;而未经过培训的3名主治医生累计完成42个标准步骤的操作,出现"打架"的次数为27次,明显高于培训医生。结论由于机器人手术没有触觉反馈,且机器臂的力量较大,彼此之间的"打架"容易造成器械损伤或针线折断。作者提出的分区理念,经过验证可以有效地降低初学者在学习这项复杂手术时出现2号臂与3号臂"打架"的频率,有一定的临床推广价值。
Objective To avoid the arm interference of 2nd and 3rd arm in robotic-assisted radical prostatectomy. Methods Applied the arm partition to avoid the arm“fight” phenomenon in robotic-assisted radical prostatectomy,especially for the beginners. The procedure of robotic-assisted radical prostatectomy was divided into 13 standard steps,and using the concept of upper and lower partition to restrict the posision of 2nd and 3rd arm relatively,such as 2nd and 3rd arm were fixed to one partition when finished one step in order to avoid the arm interference. 6 attending surgeons were divided two groups,3 attending surgeons accepted the training of concept of arm partition and the other 3 attending surgeons as control. Recording the number of fight times between 2nd and 3rd arm in operation. Results 3 attending surgeons who accepted the concept of arm partition performed 37 standard steps and the number of fight times was 8,while the other 3 attending surgeons who didn’t accept the concept of arm partition performed 42 standard steps and the number of fight times was 27,and significantly higher than the training group. Conclusions Robotic-assisted surgery lack tactile feedback and the power of the machine arm is greater,so the “fight” between the arms is likely to cause equipment damage or needle breakage. The concept of arm partition we proposed can effectively reduce the frequency of arm“fight” in this complex surgery,especially for the beginners.
出处
《中华腔镜外科杂志（电子版）》
2014年第2期135-138,共4页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
