Tomulescu V, Stănciulea O, Bălescu I, Vasile S, Tudor St, Gheorghe C, Vasilescu C, Popescu I
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Chirurgia (Bucur). 2009 Mar-Apr;104(2):141-50.
Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Since 1997 when the first robotic procedure was performed various papers pointed the advantages of robotic-assisted laparoscopic surgery, this technique is now a reality and it will probably become the surgery of the future. The aim of this paper is to present our preliminary experience with the three-arms "da Vinci S surgical system", to assess the feasibility of this technique in various abdominal and thoracic procedures and to point out the advantages of the robotic approach for each type of procedure.
Between 18 January 2008 and 18 January 2009 153 patients (66 men and 87 women; mean age 48,02 years, range 6 to 84 years) underwent robotic-assisted surgical procedures in our institution; we performed 129 abdominal and 24 thoracic procedures, as follows: one cholecystectomy, 14 myotomies with Dor fundoplication, one gastroenteroanastomosis for unresectable antral gastric cancer, one transthoracic esophagectomy, 14 gastrectomies, one polypectomy through gastrotomy, 22 splenectomies,7 partial spleen resections, 22 thymectomy, 6 Nissen fundoplications, one Toupet fundoplication, one choledocho-duodeno-anastomosis, one drainage for pancreatic abscess, one distal pancreatectomy, one hepatic cyst fenestration, 7 hepatic resections, 29 colonic and rectal resections, 5 adrenalectomies, 12 total radical hysterectomies and pelvic lymphadenectomy, 3 hysterectomies with bilateral adnexectomy for uterine fibroma, one unilateral adnexectomy, and 2 cases of cervico-mediastinal goitre resection.
147 procedures were robotics completed , whereas 6 procedures were converted to open surgery due to the extent of the lesion. Average operating room time was 171 minutes (range 60 to 600 minutes, Median length of stay was 8,6 days (range 2 to 48 days). One system malfunctions was registered. Post-operatory complications occurred in 14 cases. There were no deaths.
Our preliminary experience suggests that robotic surgery is feasible and worth of clinical application. The best indications for robotic surgery are the procedures that require a small operating field, a fine a precise dissection (suitable for pelvic and gastric lymphadenectomy, nerve sparing in total mesorectal excision) and safe intracorporeal sutures.
机器人手术是针对腹腔镜手术的局限性和缺点而开发的。自1997年首次进行机器人手术以来，各种文献都指出了机器人辅助腹腔镜手术的优势，这项技术如今已成为现实，并且很可能会成为未来的手术方式。本文的目的是介绍我们使用三臂“达芬奇S手术系统”的初步经验，评估该技术在各种腹部和胸部手术中的可行性，并指出机器人手术方法在每种手术类型中的优势。
2008年1月18日至2009年1月18日期间，我们机构有153例患者（66名男性和87名女性；平均年龄48.02岁，范围6至84岁）接受了机器人辅助手术；我们进行了129例腹部手术和24例胸部手术，具体如下：1例胆囊切除术、14例带Dor胃底折叠术的肌切开术、1例不可切除胃窦癌的胃肠吻合术、1例经胸食管切除术、14例胃切除术、1例经胃切开息肉切除术、22例脾切除术、7例部分脾切除术、22例胸腺切除术、6例Nissen胃底折叠术、1例Toupet胃底折叠术、1例胆总管十二指肠吻合术、1例胰腺脓肿引流术、1例远端胰腺切除术、1例肝囊肿开窗术、7例肝切除术、29例结肠和直肠切除术、5例肾上腺切除术、12例全子宫根治性切除术及盆腔淋巴结清扫术、3例因子宫肌瘤行全子宫切除术及双侧附件切除术、1例单侧附件切除术、2例颈纵隔甲状腺肿切除术。
147例手术通过机器人完成，6例因病变范围而转为开放手术。平均手术时间为171分钟（范围60至600分钟），中位住院时间为8.6天（范围2至48天）。记录到1次系统故障。14例发生术后并发症。无死亡病例。
我们的初步经验表明，机器人手术是可行的，值得临床应用。机器人手术的最佳适应证是那些需要小手术视野、精细精确解剖（适用于盆腔和胃淋巴结清扫、全直肠系膜切除术中保留神经）以及安全的体内缝合的手术。
