J Endourol. 2021 Feb 23. doi: 10.1089/end.2020.1059. Online ahead of print.
ABSTRACT
BACKGROUND: Suction during robotic surgery has traditionally been performed by a bedside assistant. Adequately-skilled assistants are not always available. We assessed a purpose-designed, robotic surgeon-controlled suction catheter for efficiency and safety by comparing with historic cases of suction controlled by a dedicated bedside assistant using standard rigid laparoscopic suction.
METHODS: Beginning in February 2019, the Remotely Operated Suction Irrigation (ROSI) device was used in all robotic prostatectomy (RP) procedures, which is a flexible suction catheter manipulated by the surgeon such that a bedside assistant is never required for suction. The initial 300 consecutive cases performed with ROSI were compared with the 300 immediately previous procedures using bedside-assistant suctioning.
RESULTS: There were no statistically-significant differences between groups in age, BMI, ASA score, PSA or pathological stage. Lymph node dissection was performed in all 600 patients. All 300 ROSI cases were completed without requiring switching to bedside-assistant suctioning. Estimated blood loss (102.7cc vs 120.2cc, p=0.001) and operative time (156.1min vs 149.3min, p<0.001) were slightly lower in the ROSI group. There was no statistical difference in the 90-day complication rate (Clavien ≥III) between groups, with both having 3% of patients readmitted or seen in the emergency department within 90 days of surgery.
CONCLUSION: Surgeon-controlled suction allowed more surgeon autonomy without a negative impact on efficiency or safety issues requiring “bailout” suctioning by the bedside assistant whether urgent or otherwise. Robotic surgeons without access to skilled bedside assistants should consider suctioning for themselves not unlike the norm for many laparoscopic surgeons.
PMID:33619992 | DOI:10.1089/end.2020.1059
