Stănciulea O, Eftimie M, David L, Tomulescu V, Vasilescu C, Popescu I
Department of General Surgery and Liver Transplantation "Dan Setlacec", Fundeni Clinical Institute, Bucharest, Romania.
Chirurgia (Bucur). 2013 Mar-Apr;108(2):143-51.
Minimally invasive techniques have revolutionized the field of general surgery over the few last decades. Despite its advantages, in complex procedures such as rectal surgery, laparoscopy has not achieved a high penetration rate because of its steep learning curve, its relatively high conversion rate and technical challenges. The aim of this study was to present a single center experience with robotic surgery for rectal cancer focusing mainly on early and mid-term postoperative outcome.
A series of 100 consecutive patients who underwent robotic rectal surgery between January 2008 and June 2012 was analyzed retrospectively in terms of demographics, pathological data, surgical and oncological outcomes.
Seventy-seven patients underwent robotic sphincter-saving resection, and 23 patients underwent robotic abdominoperineal resection. There were 4 conversions. The median operative time for sphincter-saving procedures was 180 min. The median time for robotic abdominoperineal resection was 160 min. The median distal resection margin of the operative specimen was 3 cm. The median number of retrieved lymph nodes was 14. The median hospital stay was 10 days. In-hospital mortality was nil. The overall morbidity was 30%. Four patients presented transitory postoperative urinary dysfunction. Severe erectile dysfunction was reported by 3 patients. The median length of follow-up was 24 months. The 3-year overall survival rate was 90%.
Robotic surgery is advantageous for both surgeons (in that it facilitates dissection in a narrow pelvis) and patients (in that it affords a very good quality of life via the preservation of sexual and urinary function in the vast majority of patients and it has low morbidity and good midterm oncological outcomes). In rectal cancer surgery, the robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field.
在过去几十年中，微创技术给普通外科领域带来了变革。尽管具有诸多优势，但在诸如直肠手术等复杂手术中，腹腔镜检查由于其陡峭的学习曲线、相对较高的转换率和技术挑战，尚未达到高普及率。本研究的目的是介绍单中心机器人直肠癌手术的经验，主要关注术后早期和中期结果。
回顾性分析了2008年1月至2012年6月期间连续接受机器人直肠手术的100例患者的人口统计学、病理数据、手术和肿瘤学结果。
77例患者接受了机器人保肛切除术，23例患者接受了机器人腹会阴联合切除术。有4例中转手术。保肛手术的中位手术时间为180分钟。机器人腹会阴联合切除术的中位时间为160分钟。手术标本的中位远端切缘为3厘米。中位淋巴结清扫数量为14个。中位住院时间为10天。住院死亡率为零。总体发病率为30%。4例患者出现术后短暂性排尿功能障碍。3例患者报告有严重勃起功能障碍。中位随访时间为24个月。3年总生存率为90%。
机器人手术对外科医生（因为它便于在狭窄骨盆中进行解剖）和患者（因为它在绝大多数患者中通过保留性功能和排尿功能提供了非常好的生活质量，并且发病率低，中期肿瘤学结果良好）都有利。在直肠癌手术中，机器人手术方法是一种有前景的替代方法，有望克服腹腔镜检查在该领域普及率低的问题。
