Langer D, Pudil J, Ryska M
Chirurgická klinika 2. LF UK a UVN Praha.
Rozhl Chir. 2006 Sep;85(9):450-4.
Laparoscopic approach profusely utilized in many surgical fields was enhanced by da Vinci robotic surgical system in range of surgery wards, imprimis in the United States today. There was multispecialized robotic centre program initiated in the Central Military Hospital in Prague in December 2005. Within the scope of implementing the da Vinci robotic system to clinical practice we executed robotic-assisted laparoscopic cholecystectomy.
We have accomplished elective laparoscopic cholecystectomy using the da Vinci robotic surgical system. Operating working group (two doctors, two scrub nurses) had completed certificated foreign training. Both of the surgeons have many years experience of laparoscopic cholecystectomy. Operator controlled instruments from the surgeon's console, assistant placed clips on ends of cystic duct and cystic artery from auxiliary port after capnoperitoneum installation. We evacuated gallbladder in plastic bag from abdominal cavity in place of original paraumbilical port. We were exploiting three working arms in all our cases, holding surgical camera, electrocautery hook and Cadiere forceps. We had been observing procedure time, technical complications connected with robotic system, length of hospital stay and complication incidence rate.
We managed to finish all operations in laparoscopic way. Group of our patients formed 11 male patients (35.5%) and 20 women (64.5%), mean aged 52.5 years in range of 27 77 years. The average operation procedure lasted 100 minutes, in the group of last 11 patients only 69 minutes. We recorded paraumbilical wound infections in 3 (9.7 %) patients. We had not experienced any technical problems with robotic surgical system. Length of hospital stay was 3 days.
Considering our initial experience with robotic lasparoscopic cholecystectomy we evaluate da Vinci robotic surgical system to be safe and sophisticated operating manipulator which however does not substitute the surgeon key-role of controlling position and decision competences. Presented results of our group are comparable to conclusions of abroad published works.
如今在美国，达芬奇机器人手术系统提升了腹腔镜手术方法在众多外科领域的广泛应用。2005年12月，布拉格中央军事医院启动了多专科机器人中心项目。在将达芬奇机器人系统应用于临床实践的过程中，我们实施了机器人辅助腹腔镜胆囊切除术。
我们使用达芬奇机器人手术系统完成了择期腹腔镜胆囊切除术。手术工作组（两名医生、两名洗手护士）完成了国外认证培训。两位外科医生都有多年腹腔镜胆囊切除术经验。术者在外科医生控制台操作器械，助手在建立气腹后通过辅助端口在胆囊管和胆囊动脉末端放置夹子。我们通过代替原来的脐部端口将胆囊装入塑料袋后从腹腔取出。我们在所有病例中都使用了三个操作臂，分别握持手术摄像头、电灼钩和卡迪尔钳。我们观察了手术时间、与机器人系统相关的技术并发症、住院时间和并发症发生率。
我们成功以腹腔镜方式完成了所有手术。我们的患者组包括11名男性患者（35.5%）和20名女性患者（64.5%），平均年龄52.5岁，年龄范围在27至77岁之间。平均手术过程持续100分钟，在最后11名患者组中仅69分钟。我们记录到3名（9.7%）患者出现脐部伤口感染。我们在机器人手术系统方面未遇到任何技术问题。住院时间为3天。
考虑到我们在机器人辅助腹腔镜胆囊切除术方面的初步经验，我们评估达芬奇机器人手术系统是一种安全且精密的手术操作器，但它并不能替代外科医生在控制位置和决策能力方面的关键作用。我们组呈现的结果与国外发表的作品结论相当。
