Moskowitz Ross M, Young Jennifer L, Box Geoffrey N, Paré Laura S, Clayman Ralph V
Department of Urology, University of California, Irvine, Irvine, California, USA.
JSLS. 2009 Jan-Mar;13(1):64-8.
Robotic technology has been used in a variety of surgical procedures for its 3D magnification and precision. Minimally invasive techniques have already become common in neurosurgery; however, robotic-assisted procedures in neurosurgery are still a relatively new frontier. This report describes the first use of robotic technology to resect a left thoracolumbar neurofibroma.
A 19-year-old male with a family history of neurofibromatosis was diagnosed with a suspected 3-cm x 4-cm neurofibroma in the T12-L1 left paraspinal area. His only complaint was back pain requiring narcotic analgesics. He had no other findings on physical examination or laboratory/radiologic workup.
After consulting urologic robotic surgeons, it was agreed to use the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) for the resection of this mass. Following retroperitoneal laparoscopic access, the urologic surgeons opened the diaphragm and began the initial mobilization of the mass laparoscopically. The robot was docked, and the neurosurgeon operated the robot at the console to resect the mass from its nerve origin. There were no complications, and the mass, a confirmed neurofibroma, was completely removed. The patient was discharged on postoperative day 2; his back pain resolved, requiring no analgesia by the end of the first postoperative week.
This case provides early evidence that robotic assistance can be successfully used for the resection of a paraspinal neurofibroma.
机器人技术因其三维放大功能和精确性已被应用于多种外科手术中。微创技术在神经外科手术中已很常见；然而，神经外科的机器人辅助手术仍是一个相对较新的领域。本报告描述了首次使用机器人技术切除左侧胸腰段神经纤维瘤的情况。
一名有神经纤维瘤病家族史的19岁男性被诊断为在T12-L1左侧椎旁区域疑似有一个3厘米×4厘米的神经纤维瘤。他唯一的主诉是背痛，需要使用麻醉性镇痛药。体格检查以及实验室/影像学检查未发现其他异常。
在咨询了泌尿外科机器人外科医生后，决定使用达芬奇机器人（直观外科公司，加利福尼亚州森尼韦尔市）切除该肿块。经腹膜后腹腔镜入路后，泌尿外科医生打开膈肌并开始在腹腔镜下初步游离肿块。机器人对接后，神经外科医生在控制台操作机器人从神经起源处切除肿块。未发生并发症，肿块经确诊为神经纤维瘤，已被完全切除。患者术后第2天出院；他的背痛消失，术后第一周结束时无需使用镇痛药。
本病例提供了早期证据，表明机器人辅助可成功用于切除椎旁神经纤维瘤。
