内窥镜机器人二尖瓣手术室作为微系统的安全性和可持续性。

Douglas A Murphy, Sergey Psarev, Amalia A Jonnson, Michael E Halkos
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引用次数: 0

摘要

目的:安全性和可持续性是机器人二尖瓣(MV)项目在任何发展阶段的关键因素。面临的挑战包括外科医生在机器人控制台的定位、患者复杂性的增加以及上游行政人员配备的困难。我们采用了一种系统方法,以最大限度地保障患者安全并维持机器人服务的可行性:方法:我们将单间专用机器人手术室(OR)作为一个微型系统来配备,并在手术步骤、人体工程学、数字工具和明确的安全文化方面进行了团队培训。对所有机器人二尖瓣手术(包括在微型系统手术室由一名外科医生进行的同期手术)的结果进行了回顾性审查:从 2014 年 1 月到 2023 年 12 月,1529 名连续的二尖瓣手术患者接受了内窥镜机器人手术。10名患者(0.65%)改用传统方法。总体而言,共进行了1300例中风修补术(85%),其中1205例患者(92.7%)的中风残余反流为零至微量,92例患者(7.1%)为轻度,3例患者(0.23%)为中度。229 名患者(15%)进行了中压置换术,无瓣旁漏。修复组死亡率为 0.08%,置换组死亡率为 0.87%。在过去的 38 个月中没有死亡病例。在修复组和置换组中,分别有0.31%和1.3%的患者发生中风。一名患者出现一过性肾功能衰竭:将机器人手术室组织成一个微型系统与手术疗效、极低的发病率和死亡率有关。使用全部或部分组件的可比微系统方法可促进各级机器人中风项目的安全性和可持续性。
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Endoscopic Robotic Mitral Operating Room as a Microsystem for Safety and Sustainability.

Objective: Safety and sustainability are key elements of a robotic mitral valve (MV) program at any stage of development. Challenges include the positioning of the surgeon at the robotic console, increasing patient complexity, and upstream administrative staffing difficulties. We instituted a systems approach to maximize patient safety and maintain robotic service viability.

Methods: A single dedicated robotic operating room (OR) was equipped as a microsystem with team training in the operative steps, ergonomics, digital tools, and an explicit culture of safety. Outcomes of all robotic mitral procedures including concomitant procedures in the microsystem OR by a single surgeon were retrospectively reviewed.

Results: From January 2014 through December 2023, 1,529 consecutive MV patients were operated with an endoscopic robotic approach. Ten patients (0.65%) were converted to conventional approaches. Overall, 1,300 MV repairs (85%) were performed with residual MV regurgitation of none to trace in 1,205 patients (92.7%), mild in 92 patients (7.1%), and moderate in 3 patients (0.23%). MV replacements were performed in 229 patients (15%) with no paravalvular leaks. Mortality was 0.08% in the repair group and 0.87% in the replacement group. No deaths have occurred in the last 38 months. Stroke occurred in 0.31% of repair patients and 1.3% of replacement patients. One patient developed transient renal failure.

Conclusions: Organization of the robotic OR as a microsystem is associated with surgical efficacy and very low morbidity and mortality. A comparable microsystem approach using all or select components may promote safety and sustainability for robotic MV programs at all levels.

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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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