Vergote Ignace, Pouseele Bram, Van Gorp Toon, Vanacker Bernard, Leunen Karin, Cadron Isabelle, Neven Patrick, Amant Frederic
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
Acta Obstet Gynecol Scand. 2008;87(7):783-7. doi: 10.1080/00016340802146946.
Retroperitoneal para-aortic laparoscopic lymphadenectomy is a technically challenging operation. The robotic Da Vinci system might be valuable in this operation due to a steady three-dimensional visualization, instrumentation with articulating tips, and an adaptive downscaling of the surgeons movements (without tremor). To the best of our knowledge, this is the first report on robotic retroperitoneal para-aortic lymphadenectomy in patients with gynecologic cancer.
We report on the technique and operative results of the robotic retroperitoneal lower para-aortic lymphadenectomy using the Da Vinci Surgical System. Five patients with cervical carcinoma stage IIb-IIb were included. Technically the procedure was easier to perform than with the classical retroperitoneal laparoscopic approach. However using the Da Vinci Surgical System it is important to tilt the patient slightly to the left to avoid collision between the left arm of the patient and the robotic arms, and to place the endoscopic robotic arm between the 2 arms used for dissection. Finally, we experienced that using a 30 degrees scope is advantageous for the dissection of the paracaval nodes. None of the patients had evidence of para-aortic metastases on preoperatively staging, including Positron Emission Tomography - Computed Tomography (PET-CT). One of the patients had positive para-aortic lymph nodes.
Here we report on the surgical technique used in our first 5 patients undergoing retroperitoneal para-aortic lymphadenectomy using the robotic Da Vinci system. It is important to adapt the surgical technique using the Da Vinci Surgical System compared with the classical laparoscopic technique.
腹膜后腹主动脉旁腹腔镜淋巴结清扫术是一项技术要求较高的手术。达芬奇机器人系统可能在该手术中具有价值，因为其具备稳定的三维可视化、带有关节式尖端的器械以及对外科医生动作的自适应缩小（无震颤）。据我们所知，这是关于妇科癌症患者机器人腹膜后腹主动脉旁淋巴结清扫术的首例报告。
我们报告了使用达芬奇手术系统进行机器人腹膜后下腹主动脉旁淋巴结清扫术的技术及手术结果。纳入了5例IIb-IIb期宫颈癌患者。从技术角度而言，该手术比传统的腹膜后腹腔镜手术更容易实施。然而，使用达芬奇手术系统时，重要的是将患者稍微向左倾斜，以避免患者左臂与机器人手臂发生碰撞，并将内镜机器人手臂置于用于解剖的双臂之间。最后，我们发现使用30度的镜头有利于腔静脉旁淋巴结的解剖。所有患者术前分期（包括正电子发射断层扫描-计算机断层扫描（PET-CT））均未发现腹主动脉旁转移的证据。其中1例患者腹主动脉旁淋巴结阳性。
在此我们报告了首批5例使用达芬奇机器人系统进行腹膜后腹主动脉旁淋巴结清扫术患者所采用的手术技术。与传统腹腔镜技术相比，使用达芬奇手术系统时调整手术技术很重要。
