機械手臂泌尿科手術的結果優於開放式手術


  【24drs.com】根據一篇新報告,泌尿科手術使用機械手臂獲得與腹腔鏡手術相當的術後結果,且這兩種手術的結果都優於開放式手術。
  
  研究者也發現,機械手臂手術的費用較高與機械手臂最初的購置費用、年度維護費用及耗材費用等有關,不過,機械手臂手術的學習曲線優於腹腔鏡手術。
  
  英國倫敦泌尿科中心的Kamran Ahmed等人在3月22日的BJU International期刊線上發表研究結果。
  
  作者們指出,機械手臂手術在前列腺癌根治術和膀胱切除術等骨盆泌尿科手術越來越普遍,不過,有些研究主張,機械手臂輔助手術使每次手術費用從1000美元(約3萬台幣)增加到2500美元(約7.5萬台幣)。
  
  研究作者試圖系統性評估有關開放式手術、腹腔鏡手術與機械手臂手術的成本效益,他們在Medline、Embase以及Web of Science等資料庫辨識了13篇符合篩選規範的研究。
  
  作者們發現,腹腔鏡手術與機械手臂輔助前列腺癌根治術在縮短住院天數(分別是1 - 1.76天與1 - 5.5天)、失血量(分別是482 - 780 mL與227 - 234 mL)等指標皆優於開放式手術(縮短住院天數和失血量分別是2 – 8天與1015 mL)。
  
  相較之下,機械手臂輔助前列腺癌根治術之費用(總費用2000 - 39,215美元)比腹腔鏡手術(740 - 29,771美元)或開放式前列腺癌根治術(1870 -31,518美元)昂貴。
  
  作者們指出,費用上的這些差異是因為購置機械手臂、維護與耗材費,縮短住院天數(1 - 1.5天)與手術時間(102 – 360分鐘)則是難以用金錢衡量;不過,機械手臂手術的學習曲線(20 – 40案例)比其他技術短,但是相關證據尚無定論。
  
  作者們結論表示,機械手臂手術的需求增加,需有相關研究探討實際的手術費用,作為病患前往醫院手術的整體考量之一。
  
  資料來源: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.

    
相關報導
心理訓練可以改善手術結果
2014/11/11 下午 05:34:19
腹腔鏡減少小腸阻塞風險
2012/4/19 上午 10:47:52
腹腔鏡前列腺切除術的學習曲線累積較慢
2009/4/8 下午 04:45:00

上一頁
   1   2   3  




回上一頁