Bodner J, Wykypiel H, Wetscher G, Schmid T
Department of General and Transplant Surgery, University Hospital Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Eur J Cardiothorac Surg. 2004 May;25(5):844-51. doi: 10.1016/j.ejcts.2004.02.001.
The da Vinci surgical robotic system was purchased at our institution in June 2001. The aim of this trial was to evaluate the applicability of the da Vinci operation robot for general thoracic procedures.
The da Vinci surgical system consists of a console connected to a surgical arm cart, a manipulator unit with two instrument arms and a central arm to guide the endoscope. The surgical instruments are introduced via special ports and attached to the arms of the robot. The surgeon, sitting at the console, triggers highly sensitive motion sensors that transfer the surgeon's movements to the tip of the instruments. The so-called 'EndoWrist technology' offers seven degrees of movement, thus exceeding the capacity of a surgeon's hand in open surgery. We evaluated the role of the robot for several thoracic procedures such as thymectomies, fundoplications, esophageal dissections, resection of mediastinal masses and a pulmonary lobectomy.
A total of 10 thymectomies, 16 fundoplications, 4 esophageal dissections, 5 extirpations of benign mediastinal masses and 1 right lower lobectomy was performed with the robot. One resection of a paravertebral neurogenic tumor had to be converted due to surgical problems. A lesion to a left recurrent laryngeal nerve caused transient hoarseness after the extirpation of an ectopic parathyroid in the aortopulmonary window in one patient. The postoperative courses were uneventful and patients were discharged between postoperative days 3 and 8 (with the exception of patients who underwent dissection for esophageal cancer and the patient with conversion to an open access).
Advanced general thoracic procedures can be performed safely with the da Vinci robot allowing precise dissection in remote and difficult-to-reach areas. This benefit becomes evident most elegantly in thymectomies, which at our institution have become a routine procedure with the robot. The rigid anatomy of the chest seems to be an ideal condition for robotic surgery. A major limitation for robotic surgery is the lack of more appropriate instruments. This disadvantage becomes most evident in pulmonary lobectomies.
2001年6月我们机构购置了达芬奇手术机器人系统。本试验的目的是评估达芬奇手术机器人在普通胸科手术中的适用性。
达芬奇手术系统由连接到手术臂推车的控制台、带有两个器械臂和一个用于引导内窥镜的中央臂的操纵器单元组成。手术器械通过特殊端口引入并连接到机器人的臂上。外科医生坐在控制台前，触发高灵敏度运动传感器，将外科医生的动作传递到器械尖端。所谓的“EndoWrist技术”提供七个运动自由度，从而超过了外科医生在开放手术中手部的能力。我们评估了该机器人在多种胸科手术中的作用，如胸腺切除术、胃底折叠术、食管解剖、纵隔肿物切除术和肺叶切除术。
使用该机器人共进行了10例胸腺切除术、16例胃底折叠术、4例食管解剖、5例良性纵隔肿物切除术和1例右下肺叶切除术。由于手术问题，1例椎旁神经源性肿瘤切除术不得不改为开放手术。1例患者在主动脉肺窗切除异位甲状旁腺后，左侧喉返神经损伤导致短暂声音嘶哑。术后过程顺利，患者在术后第3至8天出院（接受食管癌解剖的患者和改为开放手术的患者除外）。
使用达芬奇机器人可以安全地进行高级普通胸科手术，能够在偏远和难以到达的区域进行精确解剖。这一优势在胸腺切除术中最为明显，在我们机构，胸腺切除术已成为机器人的常规手术。胸部的刚性解剖结构似乎是机器人手术的理想条件。机器人手术的一个主要限制是缺乏更合适的器械。这一缺点在肺叶切除术中最为明显。
