로봇을 이용한 자궁근종절제술의 유용성: 복강경 그리고 개복수술과 비교
THE FEASIBILITY OF ROBOT-ASSISTED LAPAROSCOPIC MYOMECTOMY: COMPARED WITH STANDARD LAPAROSCOPIC AND ABDOMINAL MYOMECTOMY
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목적로봇을 이용한 자궁근종절제술을 복강경하 자궁근종절제술, 개복하 자궁근종절제술과 임상 양상 및 수술 후 경과에 대해 비교하여 보고자하였다. 연구방법2007년 1월부터 2011년 3월까지 자궁근종절제술을 시행 받은 환자를 수술방법에 따라 세 군으로 나누어 환자 및 근종의 특성, 수술 중및 수술 후 경과에 대해 후향적으로 의무기록을 분석하여 비교하였다. 결과총 206명의 환자 중 로봇을 이용한 자궁근종절제술을 시행한 환자(로봇수술 군)는 31명(15%), 복강경하 자궁근종절제술을 시행한 환자(복강경수술 군)는 70명(34%), 개복하 자궁근종절제술을 시행한 환자(개복수술 군)는 105명(51%)이었다. 로봇수술 군(164.3 ± 193.7 g)에서 제거된 근종의 무게는 개복수술 군(284.7 ± 265.6 g)과 비교했을 때에는 가벼웠지만 복강경수술 군(117.3 ± 132.7 g)에 비해서는더 무거웠다(P = 0.001). 평균 수술 중 출혈량은 개복수술 군, 로봇수술 군, 복강경수술 군 각각 456.6 ± 288.5 mL, 380.6 ± 303.8 mL,198.5 ± 137.6 mL로 개복수술 군, 로봇수술 군은 복강경수술 군에 비해 통계적으로 유의하게 출혈량이 많았다(P ＜0.001). 평균 수술시간은 로봇수술 군은 272.5 ± 116.8분, 복강경수술 군은 172.1 ± 49.4분, 개복수술 군은 152.3±45.3분이었다(P ＜0.001). 로봇수술 군의 평균 재원일수는 4.1±1.4일로 개복수술 군의 5.5 ± 1.3일에 비해 의미 있게 짧았고 복강경수술 군의 3.8 ± 1.0일과는 유의한 차이가 없었다(P ＜0.001). 결론복강경수술 군의 수술 중 출혈량은 다른 두 그룹에 비해 적었으나 제거된 근종 역시도 작았다. 그러나 로봇수술 군은 개복수술 군과 비교했을 때 근종의 크기와 수술 후 경과 면에서 뒤지지 않았다. 본 연구 결과로 미루어 볼 때 로봇을 이용한 자궁근종절제술은 개복수술을 대체할 수 있을 것으로 보이며 개복수술에 비해 로봇수술은 복강경수술의 장점인 미용적 우수성과 짧은 재원기간의 이점도 가지고 있어 거대 근층내 자궁근종을 제거하는 데 유용할 것으로 생각된다.
Abstract
Objective To compare robotic myomectomy to laparoscopic and open myomectomy. Methods We retrospectively analyzed medical records of patients undergoing myomectomy between January 2007 and March 2011. Patients were stratifi ed into three groups by surgical approach. Clinical features and surgical outcomes were compared. Results From a total of 206 myomectomies, 31 (15%) were robotic, 70 (34%) were laparoscopic, and 105 (51%) were open. Heavier myomas were removed in the robotic group (164.3 ± 193.7 g) than in the laparoscopic (117.3 ± 132.7 g) group but were lighter than the myomas removed in the open group (284.7 ± 265.6 g) (P = 0.002; open vs. laparoscopic). Greater blood loss was reported in the open and robotic groups than in the laparoscopic group with a mean blood loss of 456.6 ± 288.5 mL, 380.6 ± 303.8 mL,and 198.5 ± 137.6 mL, respectively (P < 0.001; open vs. laparoscopic, P = 0.004; robot vs. laparoscopic). Actual surgical time was 272.5 ± 116.8 minutes in the robotic, 172.1 ± 49.4 minutes in the laparoscopic (P < 0.001; robot vs. laparoscopic), and 152.3 ± 45.3minutes in the open group (P < 0.001; robot vs. open). Patients in the robotic group had shorter mean length of hospital stay of 4.1 ± 1.4 days as compared to 5.5 ± 1.3 days in the open (P < 0.001; robot vs. open) but there were no signifi cant differences between the robotic and laparoscopic groups (3.8 ± 1.0 days). Conclusion Laparoscopic group is associated with decreased blood loss but signifi cantly smaller myomas when compared with the other two groups. However, robotic myomectomy does not fall behind open myomectomy in terms of myoma size or surgical outcomes. In conclusion, robotic myomectomy can replace the role of open myomectomy.
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