Interpretation
Since Da Vinci Surgical System was imported into Chinese PLA General Hospital, the team leading by Prof. Meng has completed over 1,000 robotic-assisted gynaecological surgeries. As time went by, their surgical techniques have gradually been more mature. Owing to the balanced development of robotic-assisted surgery skills in most surgery departments, we have the opportunities to accomplish complicated gynaecological operations with other surgeons from general surgery department, urological surgery department and others from 2018 till now. Therefore, some difficult miscellaneous diseases (rare or recurrent diseases) could be solved by robotic-assisted MDT gynaecological surgeries.
Da Vinci Si Surgical System could provide clearer magnified views and the operative endo-wrists that hardly shake, so the intraoperative complications could be reduced to the great extent. Intraoperative complications occurred in approximately 10.26% of the robotic-assisted MDT gynaecological surgeries we studied. However, a German university hospital has focused on patient safety after 110 ordinary robotic-assisted gynaecological procedures, and discovered that no complications were recorded in 90 (81.8%) operations23. The comparison of the two results implied the validity and safety of adding MDT pattern into robotic-assisted surgeries. Researchers from the First Affiliated Hospital of Zhengzhou University detected 16 patients (1.6%) undergone postoperative infection after robotic-assisted gynaecological surgeries24. Banapour et.al collected 9858 patients undergone robotic surgeries in different departments and found that 4.8% of the patients appeared with wound infection while 5.7% emerged urinary tract infection25. The results indicated that larger surgical areas caused by multidisciplinary cooperative surgery were often more prone to severe infection, so the early use of strong antibiotics was necessary for the patients receiving robotic-assisted MDT surgeries.
We found that 84.62% of the cases in the study have received at least one abdominal surgery. It is estimated that more than 90% of the patients who have undergone abdominal or pelvic surgeries would develop postoperative adhesions26. Additionally, adhesions can cause increased complexity of subsequent intra-abdominal operations. So, the MDT and robotic pattern applied in gynaecological procedures could be good for separating adhesions from different parts and making sure that operations went smoothly. It was indicated that the frequency of abdominal surgeries may be one of the predictors to adopt an MDT surgery. Potential indications of robotic-assisted MDT gynaecological surgeries were mentioned above. They could further guide the application of MDT pattern using in robotic-assisted surgeries.
If the patient really needed a robotic-assisted MDT gynaecological surgery, we recommended that a preoperative discussion meeting was necessary27, and the MDT group could add more disciplines, such as pathology department, radiology department, ICU and others. A discussion checklist was also indispensable because it improved MDT ability to reach a decision from 82.2% to 92.7%28.
The MDT pattern requires a high degree of cooperation and equal communication among team members. Therefore, its implementation was bound to promote the merge of various disciplines and improve our understanding of diseases. The MDT pattern was an evolution to precise and personalized treatment. It was believed to embody the ideal concept of patient-centered and holistic treatment.