Ruurda J P, van Dongen K W, Dries J, Borel Rinkes I H M, Broeders I A M J
Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, Post Office Box 85500, 3508 GA, Utrecht, The Netherlands.
Surg Endosc. 2003 Dec;17(12):1937-42. doi: 10.1007/s00464-003-9008-x. Epub 2003 Oct 23.
Endoscopic stenting is the treatment of choice for palliative relief of biliary obstruction by a periampullary tumor. If treated surgically, a choledochojejunostomy and Roux-en-Y diversion is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. Robotic systems may enhance dexterity and vision and might therefore support surgeons in delicate laparoscopic interventions. The purpose of this study is to assess the efficacy and safety of performing a laparoscopic choledochojejunostomy and Roux-en-Y reconstruction with the aid of a robotic system.
Ten laparoscopic procedures were performed in pigs with the da Vinci robotic system and compared to 10 procedures performed by laparotomy (controls). Operation room time, anastomoses time, blood loss, and complications were recorded. The effectiveness of the anastomoses was evaluated by postoperative observation for 14 days and by measuring passage, circumference, and number of stitches.
Operating room time was significantly longer for the robot-assisted group than for controls (140 vs 82 min, p < 0.05). The anastomoses times were longer in the robot-assisted cases but not statistically significant (biliodigestive anastomosis, 29 vs 20 min; intestinal anastomosis, 30 vs 15 min), Blood loss was less than 10 cc in all robot-assisted cases and 30 cc (10-50 cc) in the controls. In both groups, there were no intraoperative complications. In the control group, one pig died of gastroparesis on postoperative day 6. In the robot-assisted group, one pig died on postoperative day 7 due to a volvulus of the jejunum. At autopsy, a bilioma was found in one pig in the robot-assisted group. In all pigs, the biliodigestive and intestinal anastomoses were macroscopically patent with an adequate passage. Circumference and number of stitches were similar.
The safety and efficacy of robot-assisted laparoscopic choledochojejunostomy was proven in this study. The procedure can be performed within an acceptable time frame.
内镜支架置入术是壶腹周围肿瘤所致胆管梗阻姑息性缓解的首选治疗方法。如果采用手术治疗，由于腹腔镜手术中胆肠吻合术存在技术挑战，大量病例仍需通过开腹进行胆总管空肠吻合术和 Roux-en-Y 改道术。机器人系统可提高灵活性和视野，因此可能有助于外科医生进行精细的腹腔镜手术。本研究的目的是评估借助机器人系统进行腹腔镜胆总管空肠吻合术和 Roux-en-Y 重建术的有效性和安全性。
使用达芬奇机器人系统对猪进行了 10 例腹腔镜手术，并与 10 例开腹手术（对照组）进行比较。记录手术时间、吻合时间、失血量和并发症。通过术后 14 天的观察以及测量通道、周长和缝线数量来评估吻合的有效性。
机器人辅助组的手术时间明显长于对照组（140 分钟对 82 分钟，p < 0.05）。机器人辅助病例的吻合时间较长，但无统计学意义（胆肠吻合，29 分钟对 20 分钟；肠吻合，30 分钟对 15 分钟）。所有机器人辅助病例的失血量均少于 10 毫升，对照组为 30 毫升（10 - 50 毫升）。两组均无术中并发症。对照组中，1 头猪在术后第 6 天死于胃瘫。机器人辅助组中，1 头猪在术后第 7 天因空肠扭转死亡。尸检时，机器人辅助组 1 头猪发现胆汁瘤。所有猪的胆肠和肠吻合在宏观上均通畅，通道足够。周长和缝线数量相似。
本研究证实了机器人辅助腹腔镜胆总管空肠吻合术的安全性和有效性。该手术可在可接受的时间范围内完成。
