114网址导航Ann Surg_文档库
文档库最新最全的文档下载
当前位置： & Ann Surg
META-ANALYSIS
EfficacyoftheDaVinciSurgicalSysteminAbdominalSurgery
ComparedWithThatofLaparoscopy
ASystematicReviewandMeta-Analysis
SergioMaeso,MD,MPH,*MercedesReza,PharmD,*JulioA.Mayol,MD,+JuanA.Blasco,MD,MPH,*
MercedesGuerra,Lic,*ElenaAndradas,MD,MPH,*andMaríaN.Plana,MD,MPH?
Aim:ThemainaimofthisreviewwastocomparethesafetyandefficacyoftheDaVinciSurgicalSystem(DVSS)andconventionallaparoscopicsurgery(CLS)indifferenttypesofabdominalintervention.
SummaryofBackgroundData:DVSSisanemerginglaparoscopictechnology.Thesurgeondirectstheroboticarmsofthesystemthroughaconsolebymeansofhandcontrolsandpedals,makinguseofastereoscopicviewingsystem.DVSSiscurrentlybeingusedingeneral,urological,gynecologic,andcardiothoracicsurgery.
Methods:ThissystematicreviewanalysesthebestscientificevidenceavailableregardingthesafetyandefficacyofDVSSinabdominalsurgery.Theresultsfoundweresubjectedtometa-analysiswheneverpossible.
Results:Thirty-onestudies,6ofthemrandomizedcontroltrials,involving2166patientsthatcomparedDVSSandCLSwereexamined.Theproceduresundertakenwerefundoplication(9studies,onealsoexaminingcholecystec-tomy),Hellermyotomy(3studies),gastricbypass(4),gastrectomy(2),bariatricsurgery(1),cholecystectomy(4),splenectomy(1),colorectalresec-tion(7),andrectopexy(1).DVSSwasfoundtobeassociatedwithfewerHellermyotomy-relatedperforations,amorerapidintestinalrecoverytimeaftergastrectomy—andthereforeashorterhospitalstay,ashorterhospitalstayfollowingcholecystectomy(althoughthedurationofsurgerywaslonger),longercolorectalresectionsurgerytimes,andalargernumberofconversionstoopensurgeryduringgastricbypass.
Conclusions:ThepublicationsreviewedrevealedDVSStooffercertainadvantageswithrespecttoHellermyotomy,gastrectomy,andcholecystec-tomy.However,theseresultsshouldbeinterpretedwithcautionuntilrandomizedclinicaltrialsareperformedand,withrespecttooncologicindications,studiesincludevariablessuchassurvival.(AnnSurg–262)
aparoscopicsurgery,whichwasintroducedin1988,hasenjoyedwideacceptanceinthefieldofgeneralsurgery,andnumerousproceduresforthisminimallyinvasiveapproachhavebeendevel-oped.Manypatientshavebenefitedfromitsuse.
Roboticsurgeryisanemergingtechnologythatallowslapa-roscopicprocedurestobefollowedinmanysurgicalsituations.It
Fromthe*HealthTechnologyAssessmentUnit,AgenciaLai?nEntralgo,Madrid,
S+GeneralandDigestiveSurgeryDepartment,HospitalClínicoSanCarlos,Madrid,Sand?ClinicalBiostatisticUnit,HospitalRamo?nyCajal,EpidemiologyandPublicHealthCIBER,Madrid,Spain.
Thispaperisbasedonahealthtechnologyassessmentreportfinancedbythe
SpanishMinistryofHealth.
SystematicreviewoftheliteratureregardingthesafetyandefficacyoftheDa
VinciSurgicalSysteminabdominalsurgery.Meta-analysisoftheresultswasperformedwheneverpossible.
Reprints:SergioMaeso,MD,MPH,HealthTechnologyAssessmentUnit,Agen-ciaLainEntralgo,GranVía27,7aplanta,28013Madrid,Spain.E-mail:smaemar@http://www.wendangku.net/doc/a2b0e72b4afe04a1b171dec6.html .
Copyright(C)2010byLippincottWilliams&WilkinsISSN:/
DOI:10.1097/SLA.0b013ee
wasfirstusedin2000aftergainingtheapprovaloftheUSFoodandDrugAdministration(FDA).Anumberofroboticsurgerydeviceshavebeendeveloped,suchastheAutomatedEndoscopicSystemforOptimalPositioning(ComputerMotion,SantaBarbara,CA),theZeusSurgicalSystem(ComputerMotion),andtheDaVinciSurgi-calSystem(DVSS;IntuitiveSurgicalInc,MountainView,Sunny-vale,CA).TheAutomatedEndoscopicSystemforOptimalPosi-tioningwasthefirstroboticdeviceapprovedbytheFDA.TheZeusSurgicalSystemdeviceinvolvesa2-dimensionalviewingsystemandtheremotecontroloftheroboticarmsisontheoperatingtable.However,thissystemisnolongercommerciallydistributed.DVSSisthenewestandmostwidelyuseddevice.
TheDVSSdevicehasacomputer-assistedroboticarmsthatallowsurgeonstooperateincertainareasofthebodyusingverysmallincisions.Bytheuseofaconsoleandwiththeaidofastereoscopicviewer,thesurgeoncontrolstheroboticarmswithhandcontrolsandpedals.Themovementsofthesurgeon’shandsaredigitalizedandtransmittedtotheroboticarms,whichmakeidenticalmovementsinthesurgicalfield.Thesearmshavejointsallowingfreemovementcomparabletothatenjoyedbyhumanarms/hands.Theyarealsofittedwithanantitremblefilter.Thesurgeonseesa3-dimensionalimageofthesurgicalfieldonamonitor,providedbythebinocularviewerontheconsole.Theimagesdisplayedshowtheintraoperativeareaandthesurgicalinstrumentsattheendsoftheroboticarms.Themovementsoftheroboticarmsceaseifthesurgeonlooksawayfromthescreen.Itshouldberememberedthattheroboticarmsfollowthemtheexperi-ence,skill,andjudgmentofthesurgeon,therefore,influencethesurgicalresultsobtained.
Thecontrolconsoleandtheroboticarmsareconnectedbymeansofadatacable.IntheUnitedStates,theFDAonlyallowstheuseofthisdevicewhenthesurgeonisinthesameroomasthepatient.Telesurgery,inwhichthesurgeonisnotinthesameroom,ispossible,althoughthisislimitedbydatatransferspeeds.
ThepotentialadvantagesofDVSSoverconventionallaparo-scopicsurgery(CLS)includeitsgreaterprecision,lowererrorrates,reducedbleeding,shorterhospitalstays,morerapidpatientrecov-ery,andreducedpain.Italsohasergonomicadvantagesforthesurgeon,eg,thesurgeonremainsseatedduringtheoperation.Three-and4-armversionsareavailable.ADVSSroboticdevicecostsabout$1million.Thesurgicalinstrumentsdesignedforusewiththeroboticarmscanbeusedamaximumof10times.
Althoughroboticsurgeryisinitsearlystages,manysurgeonshavebeguntouseitindailypractice.DVSSisnowusedingeneral,urological,gynecologic,andcardiothoracicsur-gery.Itisbeingusedforradicalprostatectomy,pyeloplasty,nephrectomy,cystectomy,esophagealsurgery,bariatricsurgery,cholecystectomy,colorectalresection,hysterectomy,cardiacsep-tum,andvalvesurgery.Thepresentworkfocusesonitsuseingeneralsurgery,suchasfundoplication,gastricbypass,chole-cystectomy,andcolorectalresection.
AnnalsofSurgeryoVolume252,Number2,August2010
254|http://www.wendangku.net/doc/a2b0e72b4afe04a1b171dec6.html
Word文档免费下载：
Sexual potency following surgery for rectal carcinoma: a follow-up of 44 patients. Ann Surg 1977; Discussion Our results are in accordance with studies ...Changing perspectives(ann surg oncol2007)_临床医学_医药卫生_专业资料 暂无评价|0人阅读|0次下载|举报文档 Changing perspectives(ann surg oncol2007)_临床医学_...? 24 ? 中华普通外科学文献 ( 电子版 )2013年 2月第7卷第 1期C hin Arch Gen Surg(Electronic Edition),February 2013,Vol 7,No.1 randomised muhi... Ann Thorac Surg:西安交通大学第二附属医院王西京教授等报道食管癌合并食管重复畸形一例_临床医学_医药卫生_专业资料。Esophageal Cancer With Esophageal ...版面费 ? 注意广告数量,以间接判断期刊质量 Chinese Medical Journal 举例 – Ann Surg ? Annals of Surgery is a monthly journal that considers for publication...Ann Surg -372; discussion 372-373 术后并发症 ? ? ? ? ? ? 吻合口瘘 纵隔感染 肺部疾患 胃排空延迟 乳糜胸 腹腔脏器疝入胸腔 食管置换的...Ann Surg -71. Bonenkamp JJ et al. NEJM -14 Sasako et al. Gastric Cancer . Lee HK et al. Br J Surg 2001;...ANN PHYS-NEW YORK ANN SURG ANN RHEUM DIS ANN THORAC SURG ANTI-CORROS METHOD M ANTON LEEUW INT J G APPL ANAL APPL ACOUST APPL BIOCHEM MICRO+ APPL ...ANN SURG AIDS PLANT PHYSIOL MOL ENDOCRINOL PROG SOLID STATE CH RNA ASTRON J NUCL PHYS B LEUKEMIA SEMIN NUCL MED J CLIN ENDOCR METAB STROKE ...AnnSurgOncol—525 1、冯常炜,王立东,侯晓华,等.1982年至1999年食管癌、贲门癌低发区和高发区患者TNM分期比较.郑州大学学报 (医学版)....}