Ballantyne Garth H, Ewing Douglas, Pigazzi Alessio, Wasielewski Annette
Division of Minimally Invasive and Telerobotic Surgery, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
Surg Laparosc Endosc Percutan Tech. 2006 Dec;16(6):406-10. doi: 10.1097/01.sle.0000213732.03204.50.
We previously reported that telerobotic-assisted laparoscopic colectomy was feasible and could be accomplished safely. Nonetheless, we found that the current iteration of da Vinci was not well suited to a lateral to medial (LtM) dissection of the colonic mesentery. The motion scaling made the large excursion arcs required for adequate exposure in a LtM dissection cumbersome to achieve.
As a result, the aim of this study was to compare the ability of the da Vinci telerobotic surgical system to perform telerobotic-assisted laparoscopic right hemicolectomy using a LtM dissection with a medial to lateral (MtL) dissection technique.
We compared 8 consecutive da Vinci-assisted laparoscopic right hemicolectomies performed using a LtM dissection to 8 consecutive operations using a MtL dissection technique. Results were compared using analysis of variance.
Age for the 2 groups were not significantly different: LtM 64 (43 to 71) years and MtL 56 (39 to 68) years. Body mass index was similar: LtM 27 (22 to 34) and MtL 25 (20 to 32) kg/m. Total surgical time (including cystoscopy and intraoperative colonoscopy) were similar: LtM 212 (188 to 610) minutes and MtL 203 (135 to 220) minutes. There was no significant difference in lymph node harvest: LtM 12 (3 to 20) lymph nodes and MtL 18 (3 to 35) lymph nodes. There were no deaths or anastomotic leaks in either groups. Median length of stay was similar for both groups: LtM 5 (3 to 10) days and MtL 4 (2 to 9) days.
da Vinci-assisted laparoscopic right hemicolectomy using a MtL dissection technique achieves similar outcomes as a LtM dissection approach.
我们之前报道过远程机器人辅助腹腔镜结肠切除术是可行的，并且能够安全完成。尽管如此，我们发现当前版本的达芬奇手术系统并不十分适合结肠系膜由外侧向内侧（LtM）的解剖。运动缩放使得在LtM解剖中充分暴露所需的大幅度弧形运动难以实现。
因此，本研究的目的是比较达芬奇远程机器人手术系统采用LtM解剖技术与由内侧向外侧（MtL）解剖技术进行远程机器人辅助腹腔镜右半结肠切除术的能力。
我们将连续8例采用LtM解剖的达芬奇辅助腹腔镜右半结肠切除术与连续8例采用MtL解剖技术的手术进行比较。使用方差分析比较结果。
两组患者年龄无显著差异：LtM组为64（43至71）岁，MtL组为56（39至68）岁。体重指数相似：LtM组为27（22至34）kg/m²，MtL组为25（20至32）kg/m²。总手术时间（包括膀胱镜检查和术中结肠镜检查）相似：LtM组为212（188至610）分钟，MtL组为203（135至220）分钟。淋巴结清扫数量无显著差异：LtM组为12（3至20）枚淋巴结，MtL组为18（3至35）枚淋巴结。两组均无死亡或吻合口漏发生。两组患者的中位住院时间相似：LtM组为5（3至10）天，MtL组为4（2至9）天。
采用MtL解剖技术的达芬奇辅助腹腔镜右半结肠切除术与LtM解剖方法取得的结果相似。
