背景:在微创肝脏手术中,用于实质横断的器械存在很大的异质性。缺乏专门设计用于肝脏的机器人实质横切的仪器。我们的目标是深入了解同步密封的安全性和有效性(直观的手术,Inc.,桑尼维尔,CA),一种新颖的双极电外科装置,在肝脏手术的背景下。
方法:本研究是对两个高容量中心使用SynchroSeal进行机器人肝切除术(RLR)的患者的前瞻性收集数据的事后分析。将SynchroSeal的结果与上一代双极封口机的结果进行了比较;血管封口机扩展(直观的手术,Inc.,桑尼维尔,CA)使用倾向评分匹配,在排除每个中心的前25个容器密封程序之后。
结果:在研究期间(2020年2月至2023年3月),使用SynchroSeal进行了符合资格标准的155个RLR(在2021年6月实施后),使用船只封口机进行了145个RLR。使用SynchroSeal进行实质切断术时取得了出色的结果;转化率低(n=1,0.6%),术中少量失血(中位数40mL[IQR10-100]),住院时间短(中位数3天[IQR2-4]),和足够的总体发病率(19.4%)以及严重的发病率(11.0%)。在匹配的比较中(n=94vsn=94),SynchroSeal减少了术中失血量(48mL[IQR10-143]vs95mL[IQR30-200],p=0.032)与容器封口机相比。其他围手术期结果相似。
结论:SynchroSeal是一种用于机器人肝实质切断术的安全有效装置。
BACKGROUND: There is much heterogeneity in the instrumentation used for parenchymal transection in minimally invasive liver surgery. Instruments specifically designed for robotic parenchymal transection of the liver are lacking. We aim to gain insight into the safety and effectiveness of the SynchroSeal (Intuitive Surgical, Inc., Sunnyvale, CA), a novel bipolar electrosurgical device, in the context of liver surgery.
METHODS: The present study is a post-hoc analysis of prospectively collected data from patients undergoing robotic liver resection (RLR) using the SynchroSeal in two high-volume centres. The results of the SynchroSeal were compared with that of the previous generation bipolar-sealer; Vessel Sealer Extend (Intuitive Surgical, Inc., Sunnyvale, CA) using propensity score matching, after excluding the first 25 Vessel Sealer procedures per center.
RESULTS: During the study period (February 2020-March 2023), 155 RLRs meeting the eligibility criteria were performed with the SynchroSeal (after implementation in June 2021) and 145 RLRs with the Vessel Sealer. Excellent outcomes were achieved when performing parenchymal transection with the SynchroSeal; low conversion rate (n = 1, 0.6%), small amounts of intraoperative blood loss (median 40 mL [IQR 10-100]), short hospital stays (median 3 days [IQR 2-4]), and adequate overall morbidity (19.4%) as well as severe morbidity (11.0%). In a matched comparison (n = 94 vs n = 94), the SynchroSeal was associated with less intraoperative blood loss (48 mL [IQR 10-143] vs 95 mL [IQR 30-200], p = 0.032) compared to the Vessel Sealer. Other perioperative outcomes were similar between the devices.
CONCLUSIONS: The SynchroSeal is a safe and effective device for robotic liver parenchymal transection.