• 沈陽軍區(qū)總醫(yī)院普通外科(遼寧沈陽 110016);

目的  總結達芬奇機器人手術系統(tǒng)在直腸癌前切除術中的應用體會。
方法  筆者于2011年5月至2012年1月期間應用腹腔鏡聯(lián)合達芬奇機器人手術系統(tǒng)實施了直腸癌前切除術11例。均采用4孔法;先行腹腔鏡探查,確定具有達芬奇機器人手術的可行性后,再在腹腔鏡引導下放置戳卡,擺放體位,經(jīng)腹壁懸吊乙狀結腸及子宮;鏡下分離解剖應用達芬奇機器人手術系統(tǒng); 直腸的離斷及吻合轉在腹腔鏡下完成。回顧性分析該11例患者的臨床資料,并總結手術體會。
結果  11例患者均順利完成手術,均未中轉開腹;手術時間210~330min,平均288.6min;術中出血量20~100ml,平均40ml;清掃淋巴結數(shù)量12~21枚/例,平均13.9枚/例;術后排氣時間18~26h,平均22h;術后住院時間7~16d,平均11.5d;術中及術后均未出現(xiàn)并發(fā)癥;術后病理學檢查示切緣均未見癌細胞殘留。
結論  應用達芬奇機器人手術系統(tǒng)實施直腸癌前切除術安全可行,其手術創(chuàng)傷小,患者術后恢復快。

引用本文: 李瑾,張成,蔣會勇,呂赤,呂晨光,郭一君,高廣榮,張雪峰. 應用達芬奇機器人手術系統(tǒng)輔助直腸癌前切除術11例體會. 中國普外基礎與臨床雜志, 2012, 19(12): 1319-1322. doi: 復制

1. Thiel DD, Winfield HN. Robotics in urology:past, present, and future[J]. J Endourol, 2008, 22(4):825-830.
2. 朱軍, 丁健華, 湯海燕, 等. 腹腔鏡與開腹全直腸系膜切除術治療中低位直腸癌的臨床對照研究[J]. 中國普外基礎與臨床雜志, 2012, 19(6):636-641.
3. Leong QM, Kim SH. Robot-assisted rectal surgery for malignancy:a review of current literature[J]. Ann Acad Med Singapore, 2011, 40(10):460-466.
4. Kwak JM, Kim SH, Kim J, et al. Robotic vs. laparoscopic resection of rectal cancer:short-term outcomes of a case-control study[J]. Dis Colon Rectum, 2011, 54(2):151-156.
5. Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome[J]. Colorectal Dis, 2012, 14(4):e134-e156.
6. Rosenberg J, Fischer A, Haglind E, et al. Current controversies in colorectal surgery:the way to resolve uncertainty and move forward[J]. Colorectal Dis, 2012, 14(3):266-269.
7. Kwon DS, Chang GJ. The role of minimally invasive surgery and outcomes in colorectal cancer[J]. Perm J, 2011, 15(3):61-66.
8. Kang J, Min BS, Hur H, et al. Transanal specimen extraction in robotic rectal cancer surgery[J]. Br J Surg, 2012, 99(1):133-136.
9. Kang J, Min BS, Park YA, et al. Risk factor analysis of postoperative complications after robotic rectal cancer surgery[J]. World J Surg, 2011, 35(11):2555-2562.
10. Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J]. Dis Colon Rectum, 2002, 45(12):1689-1694.
11. Delaney CP, Lynch AC, Senagore AJ, et al. Comparison ofrobotically performed and traditional laparoscopic colorectal surgery[J]. Dis Colon Rectum, 2003, 46(12):1633-1639.
12. Hellan M, Anderson C, Ellenhorn JD, et al. Short-term outcomesafter robotic-assisted total mesorectal excision for rectal cancer[J].Ann Surg Oncol, 2007, 14(11):3168-3173.
13. 丁超, 江志偉, 黎介壽. 達芬奇手術機器人在結直腸手術中的應用[J]. 腹腔鏡外科雜志, 2011, 16(7):556-558.
14. Baik SH, Lee WJ, Rha KH, et al. Robotic total mesorectal excision for rectal cancer using four robotic arms[J]. Surg Endosc, 2008, 22(3):792-797.
15. Kang J, Hur H, Min BS, et al. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer:starting with the perianal approach followed by robotic procedure[J]. Ann Surg Oncol, 2012, 19(1):154-155.
16. Patriti A, Ceccarelli G, Bartoli A, et al. Short-and medium-termoutcome of robot-assisted and traditional laparoscopic rectalresection[J]. JSLS, 2009, 13(2):176-183.
17. Shin JY. Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during earlyexperience[J]. J Korean Soc Coloproctol, 2012, 28(1):19-26.
18. Park YA, Kim JM, Kim SA, et al. Totally robotic surgery for rectal cancer:from splenic flexure to pelvic floor in one setup[J]. Surg Endosc, 2010, 24(3):715-720.
19. Hellan M, Stein H, Pigazzi A. Totally robotic low anterior resectionwith total mesorectal excision and splenic flexure mobilization[J]. Surg Endosc, 2009, 23(2):447-451.
20. 曾冬竹, 余佩武, 雷曉, 等. 達芬奇機器人手術系統(tǒng)在直腸癌根治術中的應用[J]. 中華消化外科雜志, 2011, 10(6):436-438.
21. deSouza AL, Prasad LM, Marecik SJ, et al. Total mesorectal excision for rectal cancer:the potential advantage of roboticassistance[J]. Dis Colon Rectum, 2010, 53(12):1611-1617.
22. Biffi R, Luca F, Pozzi S, et al. Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer[J]. J Robot Surg, 2011, 5(2):101-107.
23. Hottenrott C. Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis[J]. Surg Endosc, 2011, 25(12):3954-3956.
24. 張雪峰, 李瑾, 郭一君, 等. 達芬奇機器人手術系統(tǒng)輔助直腸前切除一例[J]. 中華臨床醫(yī)師雜志:電子版, 2011, 5(19):5843-5844.
25. Prasad SM, Maniar HS, Soper NJ, et al. The effect of robotic assistance on learning curves for basic laparoscopic skills[J]. Am J Surg, 2002, 183(6):702-707.
  1. 1. Thiel DD, Winfield HN. Robotics in urology:past, present, and future[J]. J Endourol, 2008, 22(4):825-830.
  2. 2. 朱軍, 丁健華, 湯海燕, 等. 腹腔鏡與開腹全直腸系膜切除術治療中低位直腸癌的臨床對照研究[J]. 中國普外基礎與臨床雜志, 2012, 19(6):636-641.
  3. 3. Leong QM, Kim SH. Robot-assisted rectal surgery for malignancy:a review of current literature[J]. Ann Acad Med Singapore, 2011, 40(10):460-466.
  4. 4. Kwak JM, Kim SH, Kim J, et al. Robotic vs. laparoscopic resection of rectal cancer:short-term outcomes of a case-control study[J]. Dis Colon Rectum, 2011, 54(2):151-156.
  5. 5. Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome[J]. Colorectal Dis, 2012, 14(4):e134-e156.
  6. 6. Rosenberg J, Fischer A, Haglind E, et al. Current controversies in colorectal surgery:the way to resolve uncertainty and move forward[J]. Colorectal Dis, 2012, 14(3):266-269.
  7. 7. Kwon DS, Chang GJ. The role of minimally invasive surgery and outcomes in colorectal cancer[J]. Perm J, 2011, 15(3):61-66.
  8. 8. Kang J, Min BS, Hur H, et al. Transanal specimen extraction in robotic rectal cancer surgery[J]. Br J Surg, 2012, 99(1):133-136.
  9. 9. Kang J, Min BS, Park YA, et al. Risk factor analysis of postoperative complications after robotic rectal cancer surgery[J]. World J Surg, 2011, 35(11):2555-2562.
  10. 10. Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease[J]. Dis Colon Rectum, 2002, 45(12):1689-1694.
  11. 11. Delaney CP, Lynch AC, Senagore AJ, et al. Comparison ofrobotically performed and traditional laparoscopic colorectal surgery[J]. Dis Colon Rectum, 2003, 46(12):1633-1639.
  12. 12. Hellan M, Anderson C, Ellenhorn JD, et al. Short-term outcomesafter robotic-assisted total mesorectal excision for rectal cancer[J].Ann Surg Oncol, 2007, 14(11):3168-3173.
  13. 13. 丁超, 江志偉, 黎介壽. 達芬奇手術機器人在結直腸手術中的應用[J]. 腹腔鏡外科雜志, 2011, 16(7):556-558.
  14. 14. Baik SH, Lee WJ, Rha KH, et al. Robotic total mesorectal excision for rectal cancer using four robotic arms[J]. Surg Endosc, 2008, 22(3):792-797.
  15. 15. Kang J, Hur H, Min BS, et al. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer:starting with the perianal approach followed by robotic procedure[J]. Ann Surg Oncol, 2012, 19(1):154-155.
  16. 16. Patriti A, Ceccarelli G, Bartoli A, et al. Short-and medium-termoutcome of robot-assisted and traditional laparoscopic rectalresection[J]. JSLS, 2009, 13(2):176-183.
  17. 17. Shin JY. Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during earlyexperience[J]. J Korean Soc Coloproctol, 2012, 28(1):19-26.
  18. 18. Park YA, Kim JM, Kim SA, et al. Totally robotic surgery for rectal cancer:from splenic flexure to pelvic floor in one setup[J]. Surg Endosc, 2010, 24(3):715-720.
  19. 19. Hellan M, Stein H, Pigazzi A. Totally robotic low anterior resectionwith total mesorectal excision and splenic flexure mobilization[J]. Surg Endosc, 2009, 23(2):447-451.
  20. 20. 曾冬竹, 余佩武, 雷曉, 等. 達芬奇機器人手術系統(tǒng)在直腸癌根治術中的應用[J]. 中華消化外科雜志, 2011, 10(6):436-438.
  21. 21. deSouza AL, Prasad LM, Marecik SJ, et al. Total mesorectal excision for rectal cancer:the potential advantage of roboticassistance[J]. Dis Colon Rectum, 2010, 53(12):1611-1617.
  22. 22. Biffi R, Luca F, Pozzi S, et al. Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer[J]. J Robot Surg, 2011, 5(2):101-107.
  23. 23. Hottenrott C. Robotic versus laparoscopic surgery for rectal cancer and cost-effectiveness analysis[J]. Surg Endosc, 2011, 25(12):3954-3956.
  24. 24. 張雪峰, 李瑾, 郭一君, 等. 達芬奇機器人手術系統(tǒng)輔助直腸前切除一例[J]. 中華臨床醫(yī)師雜志:電子版, 2011, 5(19):5843-5844.
  25. 25. Prasad SM, Maniar HS, Soper NJ, et al. The effect of robotic assistance on learning curves for basic laparoscopic skills[J]. Am J Surg, 2002, 183(6):702-707.