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.