Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemun-gu, 120-752 Seoul, Korea.
J Thorac Cardiovasc Surg. 2010 Jan;139(1):53-59.e1. doi: 10.1016/j.jtcvs.2009.05.030. Epub 2009 Jul 29.
To assess the feasibility and safety of robot-assisted thoracoscopic esophagectomy for esophageal cancer in the prone position.
Twenty-one patients underwent robot-assisted thoracoscopic esophagectomy in the prone position by a surgical oncologist who had no prior experience with thoracoscopic esophagectomy. Hemodynamic and respiratory parameters were serially recorded to monitor changes in prone positioning.
All thoracoscopic procedures were completed with a robot-assisted technique followed by cervical esophagogastrostomy. R0 resection was achieved in 20 patients (95.2%), and the number of dissected nodes was 38.0 + or - 14.2. Robot console time was significantly reduced from 176.3 + or - 12.3 minutes in the initial 6 patients (group 1) to 81.7 + or - 16.5 minutes in the latter 15 patients (group 2) (P = .000). In group 2, there was less blood loss (P = .018), more patients could be extubated in the operating room (P = .004), and the number of dissected mediastinal nodes tended to be increased (P = .093). There was no incidence of pneumonia or 90-day mortality. Major complications included anastomotic leakage in 4 patients, vocal cord palsy in 6 patients, and intra-abdominal bleeding in 1 patient. The prone position led to an elevation of central venous pressure and mean pulmonary arterial pressure and a decrease in static lung compliance. However, cardiac index and mean arterial pressure were well maintained with the acceptable range of partial pressure of arterial oxygen and carbon dioxide.
Robotic assistance in the prone position is technically feasible and safe. Prone positioning was well tolerated, but preoperative risk assessment and meticulous anesthetic manipulation should be carried out.
评估机器人辅助胸腔镜下食管癌俯卧位手术的可行性和安全性。
由一位没有胸腔镜食管切除术经验的外科肿瘤学家对 21 名患者进行了机器人辅助胸腔镜下食管癌俯卧位手术。连续记录血流动力学和呼吸参数，以监测俯卧位的变化。
所有胸腔镜手术均采用机器人辅助技术完成，随后行颈段食管胃吻合术。20 例（95.2%）患者达到 R0 切除，淋巴结清扫数为 38.0 ± 14.2 个。在最初的 6 例患者（第 1 组）中，机器人控制台时间为 176.3 ± 12.3 分钟，而在随后的 15 例患者（第 2 组）中为 81.7 ± 16.5 分钟，明显减少（P =.000）。在第 2 组中，出血量较少（P =.018），更多患者可在手术室拔管（P =.004），且纵隔淋巴结清扫数有增加的趋势（P =.093）。无肺炎或 90 天死亡率。主要并发症包括 4 例吻合口漏，6 例声带麻痹和 1 例腹腔内出血。俯卧位导致中心静脉压和平均肺动脉压升高，静态肺顺应性降低。然而，心指数和平均动脉压保持在可接受的动脉血氧分压和二氧化碳分压范围内。
机器人辅助在俯卧位是可行且安全的。俯卧位耐受性良好，但应进行术前风险评估和精细的麻醉操作。
