Milone Luca, Daskalaki Despoina, Fernandes Eduardo, Damoli Isacco, Giulianotti Pier Cristoforo
Division of Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood MC 958 Room 435 E, Chicago, IL, 60612, USA.
World J Surg. 2013 Dec;37(12):2747-55. doi: 10.1007/s00268-013-2276-2.
Hepatobiliary (HB) surgery is a challenging surgical subspecialty that requires highly specialized training and an adequate level of experience in order to be performed safely. As a result, minimally invasive HB surgery has been met with slower acceptance as compared to other subspecialties, with many surgeons in the field still reluctant to adopt the approach. Recently development of the robotic platform has provided a tool that can overcome many of the limitations of conventional laparoscopic HB surgery. Augmented dexterity enabled by the endowristed movements, software filtration of the surgeon's movements, and high-definition three-dimensional vision provided by the stereoscopic camera combine to allow steady and careful dissection of the liver hilum structures, as well as prompt and precise endosuturing in cases of intraoperative bleeding. These advantages have fostered many centers to widen the indications for minimally invasive HB and gastric surgery, with encouraging initial results. As one of the surgical groups that has performed the largest number of robot-assisted procedures worldwide, we provide a review of the state of the art in minimally invasive robot-assisted HB surgery.
肝胆(HB)手术是一个具有挑战性的外科亚专业,需要高度专业化的培训和足够的经验水平才能安全实施。因此,与其他亚专业相比,微创HB手术的接受度增长较慢,该领域的许多外科医生仍然不愿采用这种方法。最近,机器人平台的发展提供了一种工具,可以克服传统腹腔镜HB手术的许多局限性。由腕关节运动赋予的增强灵活性、外科医生动作的软件过滤以及立体摄像机提供的高清三维视觉相结合,使得能够对肝门结构进行稳定而精细的解剖,以及在术中出血时进行迅速而精确的腔内缝合。这些优势促使许多中心扩大了微创HB和胃手术的适应症,初步结果令人鼓舞。作为全球实施机器人辅助手术数量最多的外科团队之一,我们对微创机器人辅助HB手术的最新进展进行了综述。
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