Bae Sung Uk, Baek Se Jin, Hur Hyuk, Baik Seung Hyuk, Kim Nam Kyu, Min Byung Soh
Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea,
Surg Endosc. 2015 Jun;29(6):1303-9. doi: 10.1007/s00464-014-3805-2. Epub 2014 Aug 27.
Techniques for robotic resection of the left colon are not well defined and have not been widely adopted due to limited range of motion of the robotic arms. We have developed a dual docking technique for both the splenic flexure and the pelvis. We report our initial experience of robotic left colectomy using this technique for left-sided colon cancer.
The study group comprised 61 patients who underwent robotic left colon cancer resection using our dual docking technique between July 2008 and January 2013. Operations comprised two stages: colon mobilization (stage 1) followed by pelvic dissection (stage 2). After completion of stage 1, the robot arms were undocked and the operating table was rotated 60° counterclockwise until a 45° angle was created between the patient cart and the operating table.
All 61 procedures were technically successful without the need for conversion to laparoscopic or open surgery. Median total operation, 1st docking, and 2nd docking times were 227 min (range, 137-653 min), 4 min (range, 3-8 min), and 3 min (range, 3-9 min), respectively. Estimated blood loss was 20 ml (range, 20-2,000 ml). Median time to soft diet was 2 days (range, 2-12 days) and median length of hospital stay was 7 days (range, 4-20 days). Median total number of lymph nodes harvested was 17 (range, 3-61). According to the Clavien-Dindo classification, the numbers of complications for grades 1, 2, 3a, 3b, and 4 were 10, 2, 3, 3, and 1. There was no mortality within 30 days.
Robotic left colon cancer resection using our dual docking technique is safe and feasible. This procedure can maximize splenic mobilization in robotic colorectal surgery.
由于机器人手臂的活动范围有限，左半结肠的机器人切除术技术尚未明确界定，也未得到广泛应用。我们开发了一种用于脾曲和骨盆的双对接技术。我们报告了使用该技术进行机器人左半结肠切除术治疗左侧结肠癌的初步经验。
研究组包括61例患者，他们在2008年7月至2013年1月期间使用我们的双对接技术接受了机器人左半结肠癌切除术。手术包括两个阶段：结肠游离（第1阶段），随后是盆腔清扫（第2阶段）。第1阶段完成后，将机器人手臂松开对接，手术台逆时针旋转60°，直到患者推车与手术台之间形成45°角。
所有61例手术在技术上均获成功，无需转为腹腔镜手术或开放手术。总手术时间、首次对接时间和第二次对接时间的中位数分别为227分钟（范围137 - 653分钟）、4分钟（范围3 - 8分钟）和3分钟（范围3 - 9分钟）。估计失血量为20毫升（范围20 - 2000毫升）。开始进软食的时间中位数为2天（范围2 - 12天），住院时间中位数为7天（范围4 - 20天）。采集的淋巴结总数中位数为17个（范围3 - 61个）。根据Clavien - Dindo分类，1级、2级、3a级、3b级和4级并发症的数量分别为10例、2例、3例、3例和1例。30天内无死亡病例。
使用我们的双对接技术进行机器人左半结肠癌切除术是安全可行的。该手术可以在机器人结直肠手术中最大程度地游离脾脏。
