Gutt C N, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Büchler M W
Department of General Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
Br J Surg. 2004 Nov;91(11):1390-7. doi: 10.1002/bjs.4700.
Robotic assistance or telemanipulation is the latest technological advance in minimally invasive surgery. Its future implementation will depend on the advantages that it can provide over standard laparoscopy or open surgery.
All Medline-cited papers (from case reports to reviews) about telemanipulators used in visceral surgery were assessed. The data in each paper were analysed to enable an up-to-date review of robot-assisted abdominal surgery by the most advanced telemanipulator (da Vinci).
Most papers presented case series demonstrating the feasibility of robotic technology in performing a specific procedure. Comparative studies of robot-assisted surgery versus standard laparoscopic or open surgery were usually matched cohort studies. They generally showed an increased operating time for robot-assisted procedures but with similar rates of conversion, intraoperative and postoperative complications, and mortality in comparison to those of laparoscopic surgery. Consistent long-term follow-up data were missing and only one randomized clinical trial was conducted.
Robot-assisted surgery appears safe and feasible for certain standard surgical procedures. However, at its current level of development, it offers no clear, significant advantage over standard laparoscopic techniques.
机器人辅助或远程操作是微创手术的最新技术进展。其未来的应用将取决于它相对于标准腹腔镜手术或开放手术所能提供的优势。
评估了所有被Medline引用的（从病例报告到综述）关于在内脏手术中使用远程操作器的论文。分析每篇论文中的数据，以便通过最先进的远程操作器（达芬奇）对机器人辅助腹部手术进行最新综述。
大多数论文展示了病例系列，证明了机器人技术在执行特定手术中的可行性。机器人辅助手术与标准腹腔镜手术或开放手术的比较研究通常是匹配队列研究。这些研究总体上显示机器人辅助手术的手术时间增加，但与腹腔镜手术相比，其中转率、术中及术后并发症发生率和死亡率相似。缺乏一致的长期随访数据，仅进行了一项随机临床试验。
机器人辅助手术对于某些标准手术程序似乎是安全可行的。然而，在其目前的发展水平上，与标准腹腔镜技术相比，它没有明显的显著优势。
