机械手臂泌尿科手术的结果优于开放式手术


  【24drs.com】根据一篇新报告,泌尿科手术使用机械手臂获得与腹腔镜手术相当的术后结果,且这两种手术的结果都优于开放式手术。
  
  研究者也发现,机械手臂手术的费用较高与机械手臂最初的购置费用、年度维护费用及耗材费用等有关,不过,机械手臂手术的学习曲线优于腹腔镜手术。
  
  英国伦敦泌尿科中心的Kamran Ahmed等人在3月22日的BJU International期刊在线发表研究结果。
  
  作者们指出,机械手臂手术在前列腺癌根治术和膀胱切除术等骨盆泌尿科手术越来越普遍,不过,有些研究主张,机械手臂辅助手术使每次手术费用从1000美元(约3万台币)增加到2500美元(约7.5万台币)。
  
  研究作者试图系统性评估有关开放式手术、腹腔镜手术与机械手臂手术的成本效益,他们在Medline、Embase以及Web of Science等资料库辨识了13篇符合筛选规范的研究。
  
  作者们发现,腹腔镜手术与机械手臂辅助前列腺癌根治术在缩短住院天数(分别是1 - 1.76天与1 - 5.5天)、失血量(分别是482 - 780 mL与227 - 234 mL)等指标皆优于开放式手术(缩短住院天数和失血量分别是2 – 8天与1015 mL)。
  
  相较之下,机械手臂辅助前列腺癌根治术之费用(总费用2000 - 39,215美元)比腹腔镜手术(740 - 29,771美元)或开放式前列腺癌根治术(1870 -31,518美元)昂贵。
  
  作者们指出,费用上的这些差异是因为购置机械手臂、维护与耗材费,缩短住院天数(1 - 1.5天)与手术时间(102 – 360分钟)则是难以用金钱衡量;不过,机械手臂手术的学习曲线(20 – 40案例)比其它技术短,但是相关证据尚无定论。
  
  作者们结论表示,机械手臂手术的需求增加,需有相关研究探讨实际的手术费用,作为病患前往医院手术的整体考量之一。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6772&x_classno=0&x_chkdelpoint=Y
  

Robotic Urologic Surgery Linked to Better Outcomes Than Open

By Emma Hitt, PhD
Medscape Medical News

March 28, 2012 — The use of robotic surgery in urological procedures results in comparable postoperative outcomes to laparoscopic surgery, and both have outcomes superior to open surgery, according to a new report.

The researchers also found that the higher cost of robotic surgery is associated with the initial purchase of the robot, as well as its annual maintenance and cost of disposable equipment. However, robotic surgery may have a reduced learning curve compared with laparoscopic surgery.

Kamran Ahmed, BS, research registrar from the Guy's and St Thomas' Hospitals, Urology Centre, London, United Kingdom, and colleagues reported their findings in an article published online March 22 in BJU International.

"Robotic surgery is becoming increasingly common in pelvic urological procedures such as radical prostatectomy and cystectomy," according to the authors. However, some studies claim that robot-assisted surgery adds from $1000 to $2500 in costs to a procedure.

The authors of the current study sought to systematically evaluate the evidence regarding cost-effectiveness of open and laparoscopic surgery in relation to robotic surgery.

They identified 13 studies that met the selection criteria in the Medline, Embase, and Web of Science databases.

The authors found that laparoscopic and robot-assisted radical prostatectomy were superior with respect to a reduction in hospital stay (range, 1 - 1.76 days and 1 - 5.5 days, respectively) and blood loss (range, 482 - 780 mL and 227 - 234 mL, respectively) compared with open surgery (range, 2 - 8 days and 1015 mL for reduction in hospital stay and blood loss, respectively).

In comparison, robotic radical prostatectomy was found to be more expensive (total cost, $2000 - $39,215) compared with either laparoscopic (range, $740 - $29,771) or open radical prostatectomy (range, $1870 - $31,518).

"This difference is due to the cost of robot purchase, maintenance and instruments," the authors point out. "The reduced length of stay in hospital (range 1 - 1.5 days) and length of surgery (range 102 - 360 min) are unable to compensate for the excess costs."

However, robotic surgery may require a shorter learning curve (20 - 40 cases) compared with the other techniques, although the evidence is inconclusive, they note.

"Ever growing demands for robotic surgery should be accompanied with studies looking at the actual cost of the procedures as a whole which includes the patient journey within the hospital," the authors conclude.

The authors have disclosed no relevant financial relationships.

BJU Int. Published online March 22, 2012.

    
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