Analysis Of The Safety And Clinical Efficacy Of Da Vinci Robotic Surgical System In Large Hysterectomy

ObjectiveTo retrospectively analyze the clinical effect of Da Vinci robot-assisted hysterectomy and explore the advantages,feasibility and safety of robotic surgery.MethodsClinical data of 313 patients who needed total hysterectomy due to uterine volume enlargement at or above 12 weeks of gestation due to uterine fibroids or adenomyosis were collected from The Department of Obstetrics and Gynecology of the First Affiliated Hospital of Nanchang University from June 2017 to June 2021,and they were grouped according to uterine size.Patients with uterus size of 12-16 gestational weeks were included in the large uterus group(n=137),including 47 cases of robotic surgery,58 cases of conventional laparoscopic surgery,and 32 cases of open surgery.Patients with uterus size of 16 weeks or more were included in the super-large uterus group(n=176),including 79 cases of robotic surgery,34 cases of conventional laparoscopic surgery,and 63 cases of open surgery.The clinical data of different uterine sizes after surgical treatment were analyzed and compared.ResultsGeneral Results conditions: The differences between the different surgical methods in the large uterine group and the very large uterine groups were not clearly characterized(P> 0.05).Operation related indicators: Large uterus group:(1)The operation time of the robotic group,the laparoscopic group and the open abdominal group [(87.02±15.17min)vs(97.21±16.51min)vs(101.88±15.95min)] was statistically significant(F=9.421,P<0.05).Multiple comparisons showed that the difference between the robotic group and the laparoscopic group and open abdominal group was significant(P <0.05).(2)Intraoperative blood loss in the robotic group,laparoscopic group and open abdominal group was statistically significant[(60.11±19.79ml)vs(76.38±17.29ml)vs(97.03±11.95ml)] was statistically significant(F=45.981,P<0.05).But multiple comparisons showed that both the robotic and laparoscopic groups were significant(P <0.05).(3)The postoperative stay was statistically significant(F=14.343,P<0.05).between the robotic,laparoscopic and open the abdomen surgery groups[(5.04±0.83d)vs(5.53±1.01d)vs(6.15±0.81d)].There were significant differences between the robotic group,the laparoscopic group and the open abdominal group(P<0.05).(4)The postoperative anal exhaust time of the robot group,the laparoscopic group and the open group [(17.55±3.89h)vs(18.95±4.35h)vs(22.75±4.44h)] was statistically significant(F=10.18,P<0.05).Multiple comparisons showed that there was no significant difference between robotic group compared with traditional laparoscopy(P> 0.05),but the difference between robotic group and laparoscopic group was significant(P <0.05).(5)Blood transfusion rate,transit opening rate and intraoperative complication rate were all insignificant(P> 0.05).Super-large uterus group:(1)The operation time among the robot group,the laparoscopic group and the open the abdomen surgery group [(110.32±16.29min)vs(123.82±23.23min)vs(112.14±14.53min)] was statistically significant(F=7.608,P<0.05).Multiple comparisons showed that the difference between the robot group and the laparoscopic group was significant(P <0.05),and not significant between the robot group and the open abdomen group(P> 0.05).(2)The intraoperative blood loss among the robot group,laparoscopic group and the open abdomen group [(101.97±24.66 m L)vs(117.65±19.47ml)vs(116.03±16.36ml)] was statistically significant(F=9.769,P<0.05).Multiple comparisons showed that the robot group,the laparoscopic group and the open abdomen group were significantly different(P <0.05).(3)The postoperative length of hospitalization among the robotic group,the laparoscopic group and the open abdominal group [(6.27±1.15d)vs(6.41±1.05d)vs(6.86±1.29d)] was statistically significant(F=4.312,P <0.05),multiple comparisons showed that the robotic group was significantly different compared with the open abdominal group(P<0.05),but no significant difference in the robotic group compared to the laparoscopic group(P> 0.05).(4)The postoperative pelvic infection of the robot group,the laparoscopic group and the open group [15(19.0%)vs 5(17.6%)vs 3(4.8%)] was statistically significant(F=6.598,P<0.05).Multiple comparisons showed that there was no significant difference between the robot group and the traditional laparoscopic group(P>0.05).There were significant differences between the robot group,laparoscopic group and open abdominal group(P<0.05).(5)There were no significant differences in intraoperative blood transfusion rate,postoperative anal exhaust time and incidence of intraoperative complications among the three groups(P>0.05).Conclusion1.Compared with traditional laparoscopy,Da Vinci robot has the advantages of higher stability,higher flexibility and clearer field of vision,and is more suitable for surgery with pelvic and abdominal adhesion.2.Da Vinci robot-assisted grand hysterectomy is safe and feasible.Compared with traditional laparoscopy and laparotomy,the operation time is shorter,the intraoperative blood loss is less,and the postoperative hospital stay is shorter.3.Da Vinci robot-assisted super-large hysterectomy is safe and feasible,with shorter operation time and less intraoperative blood loss compared with traditional laparoscopy;Compared with laparotomy,there was less intraoperative blood loss and a shorter postoperative hospital stay,but a higher postoperative pelvic infection rate.4.No matter what kind of minimally invasive surgical method of super-large hysterectomy,the limitations of field of vision and space can not be ignored,especially for patients with severe pelvic and abdominal adhesion and significantly increased uterine transverse diameter,preoperative comprehensive consideration should be given to strictly grasp the surgical indications and carefully select the surgical method.