Ahmed J, Nasir M, Flashman K, Khan J, Parvaiz A
Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.
Head of Laparoscopic & Robotic Programme, Colorectal Cancer Unit, Champalimaud Clinical Foundation, Lisbon, Portugal.
Int J Colorectal Dis. 2016 Apr;31(4):869-76. doi: 10.1007/s00384-016-2503-z. Epub 2016 Feb 1.
Robotic surgery provides an alternative option for a minimal access approach. It provides a stable platform with high definition three-dimensional views and improved access, which enhances the capabilities for precise dissection in a narrow surgical field. These distinctive features have made it an attractive option for colorectal surgeons.
The aim of this study was to present a standardised technique for single-docking robotic rectal resection and to analyse clinical outcomes of the first 100 robotic rectal procedures performed in a single centre between May 2013 and April 2015.
Prospectively collected data related to 100 consecutive patients who underwent single-docking robotic rectal surgery was analysed for surgical and oncological outcomes.
Sixty-six patients were male, the median age was 67 years (range-24-92). Eighteen patients had neo-adjuvant chemoradiotherapy whilst 23 patients had BMI >30. Procedures performed included anterior resection (n = 74), abdominoperineal resection (n = 10), completion proctectomy (n = 9), restorative proctectomy with ileal pouch-anal anastomosis (IPAA) (n = 5) and Hartmann's procedure (n = 2). The median operating time was 240 min (range-135-456), and median blood loss was 10 ml (range 0-200). There was no conversion or intra-operative complication. Median length of stay was 7 days (range, 3-48) and readmission rate was 12 %. Thirty-day mortality was zero. Postoperatively, two patients had an anastomotic leak whilst two had small bowel obstruction. The median lymph node harvest was 18 (range, 6-43).
The single-docking robotic technique should be considered as an alternative option for rectal surgery. This approach is safe and feasible and in our study it has demonstrated favourable clinical outcomes.
机器人手术为微创入路提供了一种替代选择。它提供了一个稳定的平台，具有高清三维视野并改善了入路，增强了在狭窄手术视野中进行精确解剖的能力。这些独特的特征使其成为结直肠外科医生颇具吸引力的选择。
本研究的目的是介绍一种单对接机器人直肠切除术的标准化技术，并分析2013年5月至2015年4月在单一中心进行的前100例机器人直肠手术的临床结果。
对前瞻性收集的100例连续接受单对接机器人直肠手术患者的数据进行分析，以评估手术和肿瘤学结果。
66例为男性，中位年龄为67岁（范围24 - 92岁）。18例患者接受了新辅助放化疗，23例患者的体重指数>30。实施的手术包括前切除术（n = 74）、腹会阴联合切除术（n = 10）、根治性直肠切除术（n = 9）、回肠储袋肛管吻合术（IPAA）的根治性直肠切除术（n = 5）和哈特曼手术（n = 2）。中位手术时间为240分钟（范围135 - 456分钟），中位失血量为10毫升（范围0 - 200毫升）。无中转手术或术中并发症。中位住院时间为7天（范围3 - 48天），再入院率为12%。30天死亡率为零。术后，2例患者发生吻合口漏，2例患者发生小肠梗阻。中位淋巴结清扫数为18个（范围6 - 43个）。
单对接机器人技术应被视为直肠手术的一种替代选择。该方法安全可行，在我们的研究中已显示出良好的临床结果。
