全国115家医院机器人外科手术系统使用及管理现状调查

Application and Management of Robotic Surgery System in 115 Hospitals

目的调查全国机器人外科手术系统使用及管理现状,为制定机器人外科手术系统使用、维护及管理规范提供依据。方法采用问卷调查法,对全国拥有机器人外科手术系统医院的手术室护士长进行调查。结果115家医院153台机器人手术设备中,达芬奇机器人外科手术系统所占比例为96.1%,而我国自主研发的机器人设备占比为2.6%;手术量排名前3的专科分别为泌尿外科(90.4%)、胃肠外科(55.7%)、妇产科(43.5%);机器人手术设备日常维护保养的主要人员是机器人辅助手术配合护士(59.1%);82.6%的医院每台设备每年会发生1~3次非计划性维修,非计划性维修频率最高的部件为机械臂(44.4%);68.7%的护士长认为在机器人辅助手术管理过程中,主要压力来源于设备维护成本高;而机器人辅助手术专科护理团队目前存在的主要问题是缺乏科学培训与考核标准(68.7%)、有资质的专科护士短缺(65.2%);97.4%的护士长认为相关部门出台机器人辅助手术管理规范将有助于其工作的开展;60.9%的护士长认为目前急需解决的问题是相关管理标准出台。结论机器人手术设备使用较为广泛,但我国自主研发手术机器人占比极低,应加快推进国产手术机器人设备的研发与使用;设备维修成本高且非计划性维修发生频率高,国家相关部门、学术组织及制造厂商应出台机器人辅助手术设备使用、维护保养规范,健全设备故障相关不良事件上报系统,保障患者手术安全;机器人辅助手术护理专科护士面临着缺乏培训及考核标准、专科护士短缺的问题,相关部门应制定机器人辅助手术专科护士培训方案及考核标准,提高手术护理同质化,缓解人力资源相对不足,促进机器人辅助专科手术护理的发展。

Objective To investigate the application and management of robotic surgery system in domestic hospitals,and to provide reference for the application,maintenance and standardized management of robotic surgery system.Methods A survey was conducted among the head nurses from hospitals with robotic surgery system.Results The da Vinci system accounted for 96.1%of the 153 robotic surgery systems in 115 domestic hospitals,while the proportion of robotic surgery systems developed by our country was only 2.6%.The top three departments to have surgery with robotic surgery system were department of urology surgery(90.4%);department of gastrointestinal surgery(55.7%)and department of gynaecology and obstetrics(43.5%).Daily maintenance of the systems was mainly conducted by nurses(59.1%)that were in cooperation with robotic surgery systems.One to three times unscheduled maintenance per system occurred in 82.6%of the hospitals annually,and the part with the highest frequency of maintenance was robotic arm(44.4%);68.7%of the head nurses considered that major management pressure of robotic surgery system was from the high maintenance cost.Lack of scientific training and assessment standard(68.7%)and lack of qualified nurse specialists(65.2%)were the major obstacles in the management of the system and 60.9%of the head nurses believed that the urgent problem was the development of management standard.Conclusion Robotic surgery system is widely used in China but very few is developed by our country.Development and application of domestic robotic surgery system is in urgent need.High maintenance cost and high frequency of unscheduled maintenance suggest that application and maintenance specifications,and adverse event reporting system should be required to guarantee the safety of the patients.Lack of training and assessment standard and lack of nurse specialists are suggestive of the development of training and assessment standards should be considered so as to promote the development of robot-assisted surgery nursing.