基于5G通讯技术的国产机器人辅助远程肾切除术初步结果分析

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目的:探讨基于5G通讯技术采用国产手术机器人实施远程肾切除术的可行性和安全性。方法:回顾性分析2021年3—4月由青岛大学附属医院完成的3例远程国产机器人辅助腹腔镜无功能肾切除术患者的临床资料。男2例,女1例;平均年龄61(49~73)岁;体质指数平均23.73(20.00~27.76)kg/mn 2。美国麻醉医师协会(ASA)分级2级1例,3级2例。患者均符合无功能肾切除术的手术指征。实施手术的主刀医生于青岛大学附属医院通过控制操作台(主系统),远程操纵其他地区3家基层医院(网络通讯距离分别为82.5、141.0、229.0 km)的床旁操作系统(从系统),利用5G无线通讯技术传输图像和操作指令,进行远程肾切除术。总结术中网络情况、机器人运行情况以及患者的围手术期数据。n 结果:3例远程手术均顺利完成。3例手术的网络信号延迟时间平均27.3(23~30)ms,未出现数据包丢失现象,总延迟时间平均177.3(173~180)ms;肾切除时间平均79.3(52~111) min;术中出血量平均31.1(15.6~41.9)ml。术中未发生网络相关不良事件;器械相关不良事件发生3次,均表现为操纵臂和床旁机械臂的主、从运动不一致,按复位键清除操作误差后修复,均未对手术结果造成影响。术后排气时间平均60.5(38.5~78.0)h,术后24h VAS评分平均3.7(3~4)分;3例术后并发症Clavien-Dindo分级均为Ⅰ级。术后30d复查,患者均无明显异常,随访6个月患者均康复顺利。结论:基于5G通讯技术行国产机器人辅助腹腔镜远程肾切除术,无严重不良事件及手术并发症发生,该技术安全、可行,但结论尚需大样本多中心的前瞻性研究进一步验证。“,”Objective:To explore the feasibility and safety of long-distance urological nephrotomy with the support of 5G communication technology by using the domestic robot.Methods:Clinical data of the patients with remote robot-assisted laparoscopic nephrectomy, which were completed from March to April 2021 by the Affiliated Hospital of Qingdao University (as the host hospital where the main operating system located) were retrospectively analyzed. There were 3 patients, including 2 males and 1 female.The average age was 61 (49-73) years, and the average body mass index was 23.73 (20.00-27.76) kg/mn 2. One patient had a ASA classification of grade 2, and the other 2 patients had grade 3. All patients met the surgical criteria for non-functional nephrectomy. The chief surgeon who performing the telesurgery was located at the Affiliated Hospital of Qingdao University. The surgeon remotely controlled the bedside operating system (slave system) in 3 local hospitals located in other cities in Shandong Province (network communication distances of 82.5, 141 and 229 km, respectively) by manipulating the master system located in Qingdao. Images and operating instructions during surgery were transmitted using 5G wireless communication technology. Intraoperative network conditions, robot operation, and patient perioperative data were summarized.n Results:All 3 tele-nephrectomies were successfully completed. The average network signal latency time was 27.3 (23-30) ms, with no packet loss, and the average total latency time was 177.3(173-180) ms. The mean resection time was 79.3 (52-111) min, and the average intraoperative blood loss was 31.1 (15.6-41.9) ml. There were no network related adverse events occurred during the operation, and the robot-related adverse events occured 3 times, all three of which were characterized by inconsistent master and slave movements of the manipulator arm and the bedside robotic arm. None of these adverse events affected the successful performance of the telesurgery. The mean postoperative exhaust time was 60.5 (38.5-78.0) h. The mean postoperative VAS score at 24 hours was 3.7 (3-4). The Clavien-Dindo classification were all grade I. No significant abnormality was found on the 30th day after surgery, and the patients recovered well at the follow-up until 6 months postoperatively.Conclusions:It is safe and feasible to perform remote robot-assisted laparoscopic nephrectomy based on 5G communication technology with no serious adverse events or surgical complications.However, the conclusion needs to be further verified by large sample and multi-center prospective study.
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