| BackgroundDa Vinci robot is an advanced equipment in the field of medical surgery.It has the advantages of three-dimensional vision,flexible inner wrist system and tremor filtering function,which help the surgeon complete more complicated operations with more meticulous manipulate.Many scholars have done a lot of research to certificate the safety and feasibility of da Vinci robotic surgery since the FDA approved the da Vinci robot for gynecological durgery in 2005.In recent years,with the deepening of minimally invasive concepts and the development of laparoscopic surgery techniques,da Vinci robotic surgery has begun to be widely used in gynecology.Robot-assisted laparoscopic surgery has gradually developed from its initial application in salpingectomy,oophorectomy,hysterectomy,myoectomy,sacral vaginal fixation,cystectomy and other benign diseases to radical hysterectomy,staging surgery for endometrial carcinoma,staging surgery for ovarian cancer,extensive vulvectomy and other malignant diseases.Complication refers to the occurrence of another disease or symptom caused by a disease in the development process or in the process of diagnosis and treatment.It is an inevitable part of the surgical treatment of disease.Slight complications increase the patient’s pain and prolong patient’s hospital stay;severe ones affect the quality of life of patients,and can even be life-threatening.Seasonable detection and active treatment of complications is an important part of postoperative treatment.At present,the application of robotic-assisted surgery in gynecology is gradually increasing,this article aims to explore the safety and effectiveness of its application in various gynecological operations,and analyze the perioperative complications.ObjectiveTo analyze the clinical data of 1080 da Vinci robotic surgery patients completed in gynecological minimally invasive center of the First Affiliated Hospital of Zhengzhou University,and to investigate the occurrence of perioperative complications and the influencing factors.MethodsThe clinical data of 1080 da Vinci robotic surgery performed in gynecological minimally invasive center of the First Affiliated Hospital of Zhengzhou University from October 2014 to December 2019 were analyzed.The comparison between different groups consist of patient’s age and other basic information,surgery-related indicators,intraoperative complications,and postoperative complications within half a year after the surgery.We classified all these cases according to surgical procedures,and compare the differences in the occurrence of complications.The data were analyzed using SPSS 21.0.ResultsFrom October 2014 to December 2019,1080 da Vinci robotic surgeries were successfully completed by our center,and there were no cases of conversion to laparotomy.(1)There was no significant difference among different groups in general data(patient’s age,BMI,previous pelvic or abdominal operation history,comorbidities)(P>0.05).The clinical data were comparable.There were significant differences in surgery time,surgery blood loss and the length of hospital stay among different diseases(P<0.05).(2)There were 26 cases of intraoperative injuries.The incidence in cervical cancer surgery and ovarian cancer surgery was higher than other diseases(χ2=18.331,P<0.05),but there was no statistics difference between cervical cancer and ovarian cancer(P>0.05).(3)There were 139 cases of various postoperative complications.The incidence of grade II Clavien-Dindo complications was higher than other grades.The incidence in malignant disease surgery was higher than that of benign disease surgery(15.2%vs 4.0%,P<0.05).However,there was no statistics difference among differing malignant diseases(P>0.05).(4)Univariate analysis shows that the patient’s age,BMI,previous abdominal surgery history,malignant diseases,operation time,and comorbidities(hypertension,coronary heart disease,diabetes,etc)are influencing factors to postoperative complications(P<0.05).Multivariate logistic regression analysis shows that patients’ age≥40,BMI≥25kg/m2,previous pelvic or abdominal surgery history,malignant diseases and comorbidities(hypertension,coronary heart disease,diabetes mellitus,etc)are independent influential factors to postoperative complications(P<0.05).Conclusion1.Da Vinci robotic system is safe and feasible in gynecological surgery.2.Intraoperative complications are mostly occurred in surgery for cervical cancer and ovarian cancer.3.The occurrence of postoperative complications varies form different surgeries.Clavien-Dindo grade II postoperative complications occupies most of the postoperative complications,and usually occur in surgery for malignant diseases.4.Patients’ age≥ 40,BMI≥ 25kg/m2,previous pelvic or abdominal surgery history,malignant diseases and comorbidities(hypertension,coronary heart disease,diabetes mellitus,etc)are influencing factors to postoperative complications. |
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