Lujan Henry J, Molano Andres, Burgos Alfredo, Rivera Brian, Plasencia Gustavo
1 Jackson Medical Group Specialty Physicians, Jackson South Community Hospital , Miami, Florida.
J Laparoendosc Adv Surg Tech A. 2015 Feb;25(2):117-22. doi: 10.1089/lap.2014.0199. Epub 2015 Jan 26.
In laparoscopic right hemicolectomy (LRC), extracorporeal or intracorporeal (ICA) anastomosis can be performed. Several authors have suggested advantages to ICA. This study reports our transition to and our experience with robotic right colectomy (RRC) with ICA.
From June 2009 to September 2012 we performed 58 consecutive RRCs, of which 52 were with ICA. Data were prospectively stored and retrospectively reviewed.
Twenty-eight female and 30 male patients with a mean age of 71.6 ± 8.3 years (range, 52-89 years) were studied. Indications for surgery included adenocarcinoma (n=30), adenoma (n=20), diverticulitis (n=1), and Crohn's disease (n=1). For RRC with ICA (n=52), mean operative time (OT) was 193.2 ± 42.2 minutes (range, 123-239 minutes). Mean estimated blood loss (EBL) was 47.8 ± 59.5 mL (range, 5-300 mL). Mean length of hospital stay (LOS) was 3.7 ± 3.2 days (range, 1-21 days). Mean extraction-site incision size was 4.61 ± 0.78 cm (range, 2.5-6.5 cm). Mean lymph node harvest was 20.7 ± 8.2 (range, 6-40). Mean specimen length was 18.9 ± 7.2 cm (range 10-37). No intraoperative complications, conversions, or 30-day mortality occurred. Nine postoperative complications (19.1%) occurred, with one anastomotic leak (1.7%). For LRC with ICA as reported in the literature, OT ranges from 136 to 190 minutes, EBL ranges from 0 to 500 mL, median LOS ranges from 3 to 5 days, complication rates range from 6% to 15%, with ileus <22%, and conversion rates are <5%.
RRC with ICA is safe and feasible. OTs and outcomes compare favorably with those published in the literature for LRC with ICA. The robot may facilitate transition to ICA, and if future studies confirm advantages of ICA, the role of RRC may gain importance.
在腹腔镜右半结肠切除术（LRC）中，可以进行体外或体内（ICA）吻合。几位作者提出了ICA的优势。本研究报告了我们向机器人辅助右半结肠切除术（RRC）并采用ICA的转变过程及经验。
2009年6月至2012年9月，我们连续进行了58例RRC，其中52例采用ICA。数据前瞻性存储并进行回顾性分析。
共研究了28例女性和30例男性患者，平均年龄71.6±8.3岁（范围52 - 89岁）。手术适应证包括腺癌（n = 30）、腺瘤（n = 20）、憩室炎（n = 1）和克罗恩病（n = 1）。对于采用ICA的RRC（n = 52），平均手术时间（OT）为193.2±42.2分钟（范围123 - 239分钟）。平均估计失血量（EBL）为47.8±59.5毫升（范围5 - 300毫升）。平均住院时间（LOS）为3.7±3.2天（范围1 - 21天）。平均切口提取部位大小为4.61±0.78厘米（范围2.5 - 6.5厘米）。平均清扫淋巴结数为20.7±8.2个（范围6 - 40个）。平均标本长度为18.9±7.2厘米（范围10 - 37厘米）。未发生术中并发症、中转开腹或30天内死亡。发生了9例术后并发症（19.1%），其中1例吻合口漏（1.7%）。文献报道的采用ICA的LRC，OT范围为136至190分钟，EBL范围为0至500毫升，中位LOS范围为3至5天，并发症发生率范围为6%至15%，肠梗阻发生率<22%，中转开腹率<5%。
采用ICA的RRC安全可行。其OT和结果与文献报道的采用ICA的LRC相比具有优势。机器人可能有助于向ICA的转变，如果未来研究证实ICA的优势，RRC的作用可能会更加重要。
