Bodner Johannes, Augustin Florian, Wykypiel Heinze, Fish John, Muehlmann Gilbert, Wetscher Gerold, Schmid Thomas
Department of General and Transplant Surgery, Innsbruck Medical University, Austria.
Swiss Med Wkly. 2005 Nov 19;135(45-46):674-8. doi: 10.4414/smw.2005.11022.
The recently introduced robotic surgical systems were developed to overcome the limitations of conventional minimally invasive surgery. We analyse the impact of the da Vinci robotic system on general surgery.
The da Vinci operating robot is a telemanipulation system consisting of a surgical arm cart, a master console and a conventional monitor cart. Since its purchase in June 2001, 128 patients have undergone surgery using the da Vinci robot in our department. The mean age of the 78 female and 50 male patients was 52 (range 18-78) years.
The procedures included 29 cholecystectomies, 16 partial fundoplications, 16 extended thymectomies, 14 colonic interventions, 10 splenectomies, 10 bariatric procedures, 7 hernioplasties, 6 oesophageal interventions, 5 adrenalectomies, 5 lower lobectomies, 4 neurinomectomies and 6 others. 122 of 128 procedures (95%) were completed successfully with the da Vinci robot. Open conversion proved necessary in 4 patients due to surgical problems, and two other procedures were completed by conventional laparoscopy due to robot system technical errors. 30-day mortality was 0%, one redo-operation was necessary and two lower complications not requiring surgical re-intervention occurred. The resection margins of all tumour specimens were histologically tumour free.
Various general surgical procedures have proved feasible and safe when performed with the da Vinci robot. The advantage of the system is best seen in tiny areas difficult of access and when dissecting delicate, vulnerable anatomical structures. However, in view of longer operating times, higher costs and the lack of adequate instruments, robotic surgery does not at the moment represent a general alternative to conventional minimally invasive surgery.
最近引入的机器人手术系统旨在克服传统微创手术的局限性。我们分析了达芬奇机器人系统对普通外科手术的影响。
达芬奇手术机器人是一种远程操作手术系统，由一个手术臂推车、一个主控制台和一个传统的监视器推车组成。自2001年6月购买以来，我科室已有128例患者使用达芬奇机器人进行了手术。78例女性和50例男性患者的平均年龄为52岁（范围18 - 78岁）。
手术包括29例胆囊切除术、16例部分胃底折叠术、16例扩大胸腺切除术、14例结肠手术、10例脾切除术、10例减肥手术、7例疝修补术、6例食管手术、5例肾上腺切除术、5例下叶切除术、4例神经鞘瘤切除术以及6例其他手术。128例手术中有122例（95%）使用达芬奇机器人成功完成。由于手术问题，4例患者需要转为开放手术，另外2例手术因机器人系统技术故障通过传统腹腔镜完成。30天死亡率为0%，有1例需要再次手术，发生了2例无需手术再次干预的较低级别并发症。所有肿瘤标本的切除边缘在组织学上均无肿瘤。
使用达芬奇机器人进行各种普通外科手术已证明是可行且安全的。该系统的优势在难以到达的微小区域以及解剖精细、脆弱的解剖结构时最为明显。然而，鉴于手术时间较长、成本较高以及缺乏足够的器械，目前机器人手术还不能完全替代传统的微创手术。
