Science and Ethics in Conducting Cardiothoracic Surgery with Da Vinci Surgical System in China: A Systematic Review_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIHong-hao ¹ , LIUXue-mei ² , ZANYi-heng ³ , WENJin ¹ , HUANGGang ⁴ , QIANYong-jun ⁵ , LIYan ⁶ ,  ZHENGShang-wei ¹

1. Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China Periodical Press, Sichuan University, Chengdu 610041, P. R. China;
3. West China Medical School of Sichuan University, Chengdu 610041, P. R. China;
4. Zhanjiang Normal University, Zhanjiang 524048, P. R. China;
5. Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
6. School of Political Science of Sichuan University, Chengdu 610065, P. R. China;

Corresponding?author：

ZHENGShang-wei, Email: zsw002@cd120.com

Keywords：

Systematic review; Da Vinci Surgical System; Science; Ethics; Cardiothoracic surgery

DOI：

10.7507/1007-4848.20140105

Video：

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Objective To systematically evaluate the effectiveness, safety and ethics of Da Vinci Surigcal System (dVSS)in the field of cardiothoracic surgery, and provide evidence for its clinical application. Methods We searched VIP, CNKI, WanFang Database, CBM, official website of National Health and Family Planning Commission of People's Republic of China, PubMed, Cochrane Library, Google Scholar, WHO ICTRP search portal, ClinicalTrials.gov, Chinese Clinical Trial Registration Center, Australian-New Zealand Clinical Trials Registry and ISRCTN to collect clinical trials of dVSS for thoracic and cardiovascular diseases to evaluate its effectiveness, safety and ethics. The search time was from the establishment of each database to January 2014. The quality of included literatures was evaluated by Grades of Recommendations Assessment, Development and Evaluation (GRADE). Results A total of 31 studies were identified including 4 case control studies and 27 retrospective studies involving 1 037 patients. The quality of included literatures was all very low. dVSS had been widely used in cardiothoracic surgery including coronary artery bypass grafting, valvuloplasty or valve replacement, thoracic tumor resection, etc. Compared with conventional surgery and thoracoscopy, the safety and effectiveness of dVSS was good, while its economic burden was heavier for the patients. dVSS could benefit patients and improve clinical level of cardiothoracic surgery. The disciplines and qualification of dVSS application was legal, but the maturity of its clinical use needed improvement, and relevant measures were required. The ethics in the research, introduction and application of dVSS had some problems which deserved more attention. Conclusions Clinical use of dVSS in cardiothoracic surgery is relatively safe and effective, but research quality needs to be improved. More studies on the economics and ethics of dVSS are needed in the field of cardiothoracic surgery. Relevant measures of precaution, accountability and patient protection are required to further improve clinical application of dVSS in cardiothoracic surgery, and whole-process ethical supervision should be conducted with the help of existing clinical ethical review platform.

Citation： LIHong-hao, LIUXue-mei, ZANYi-heng, WENJin, HUANGGang, QIANYong-jun, LIYan, ZHENGShang-wei. Science and Ethics in Conducting Cardiothoracic Surgery with Da Vinci Surgical System in China: A Systematic Review. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 380-388. doi: 10.7507/1007-4848.20140105 Copy

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1. Pugin F, Bucher P, Morel P. History of robotic surgery:from Aesop and EUS to da Vinci. J Visc Surg, 2011, 148:e3-e8.
2. 嵇武.手術機器人的應用進展與前景展望.醫學研究生學報, 2010, 23 (9):994-998.
3. 王國民.手術機器人是未來方向不能取代醫生.醫學論壇報, 2013.
4. 魯棒.達芬奇機器人手術系統最新應用統計數據.機器人技術與應用, 2013, 3:18.
5. Palep JH. Robotic assisted minimally invasive surgery. J Minim access, 2009, 5 (1):1-7.
6. 陳秀.達芬奇手術機器人在胸外科的應用.中華腔鏡外科雜志:電子版, 2010, 3 (4):302-305.
7. Rodrigues E, Chitwood WR. Robotics in cardiac surgery. Scand J Surg, 2009, 98 (2):120-124.
8. 潘冬青."達芬奇"機器人手術中常見的故障原因分析及對策.醫學研究生學報, 2013, 26 (1):52-53.
9. Lotan Y, Cadeddu JA, Gettman MT. The new economics of ridical prostatectomy; cost comparison of open, laparoscopic and robot assisted techniques, J Urol, 2004, 172:1431-1435.
10. Anderson JK, Murdock A, Cadeddu JA, et al. Cost comparison of laparoscopic versus radical retropubic prostatectomy. Urology, 2005, 66 (3):557-560.
11. Link RE, Su LM, Bhayani SB, et al. Making ends meet:a cost comparison of laparoscopic and open radical retropubic prostatectomy. J Urol, 2004, 172 (1):269-274.
12. 王先進, 鐘山, 沈周俊.機器人手術的經濟學探討.上海醫學, 2011, 34 (1):70-73.
13. 黃鋼, 王亞靜, 馬紅霞, 等.關于限制性醫療技術臨床準入倫理評價標準體系的構建研究.中國醫學倫理學, 2009, 22 (3):9-13, 16.
14. Guyatt GH, Oxman AD, Vist G, et al. GRADE:an emerging con-sensus on rating quality of evidence and strength of recommenda-tions. BMJ, 2008, 336 (7650):924-926.
15. Gordon HG, Andrew DO, Kunz R, et al. GRADE指南:Ⅰ.導論-GRADE證據概要表和結果總結表.中國循證醫學雜志, 2011, 11 (4):437-445.
16. Gordon HG, Andrew DO, , Kunz R, et al. GRADE指南:Ⅱ.構建問題, 確定重要結果.中國循證醫學雜志, 2011, 11 (4):446-450.
17. Balshem H, Helfanda M, Schunemann HJ, et al. GRADE指南:Ⅲ.證據質量分級.中國循證醫學雜志, 2011, 11 (4):451-455.
18. Gordon HG, Andrew DO, Vist G, et al. GRADE指南:Ⅳ.證據質量分級-研究的局限性:偏倚風險.中國循證醫學雜志, 2011, 11 (4):456-463.
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