The Hamlyn Centre for Surgical Robotics, Institute of Global Health Innovation, Imperial College London, London, UK.
J Robot Surg. 2012 Jun;6(2):99-114. doi: 10.1007/s11701-011-0308-1. Epub 2011 Sep 27.
The feasibility of robotic surgery has been extensively explored over the past decade with a more recent shift towards defining focused clinical applications for which quantifiable patient benefits can be directly attributed to its use. The aim of this article is to review the current literature on the use of daVinci robotic surgery for the management of rectal cancer and identify the potential benefits, if any, that robotic-assisted total mesorectal excision (RTME) may provide over the current conventional approach. A comprehensive search strategy was used to identify relevant evidence in order to explore the oncological, operative and functional outcome measures for the RTME in addition to quantifying the level of evidence which describes the clinical effectiveness of the daVinci robot in oncological surgery. Both robotic assisted techniques and the primary outcomes are discussed. In total, 23 studies were reviewed across 11 institutions, including one pilot randomised control trial. When data repetition is disregarded, a total of 452 robotic assisted laparoscopic anterior resections and 60 robotic-assisted laparoscopic abdomino-perineal excision of the rectum have been published since the introduction of the daVinci into clinical practice. Feasibility of the daVinci robotic assisted total mesorectal excision is demonstrated, with comparable oncological outcomes presented for rectal cancer excision. A demonstration of a reduced open conversion rate as well as of reduced hospital stay with the use of the robot is highlighted, although further trials are required to confirm both these findings. No functional benefit in using the daVinci could be confirmed due to the lack of focused trials in this area.
在过去的十年中，机器人手术的可行性已经得到了广泛的探索，最近的趋势是确定其具体的临床应用，这些应用可以直接归因于机器人手术为患者带来的可量化的益处。本文旨在回顾达芬奇机器人手术在直肠癌治疗中的应用，并确定机器人辅助全直肠系膜切除术（RTME）相对于传统方法可能带来的潜在益处。采用全面的搜索策略来确定相关证据，以探讨 RTME 的肿瘤学、手术和功能结果指标，并量化描述达芬奇机器人在肿瘤手术中的临床效果的证据水平。讨论了机器人辅助技术和主要结果。总共在 11 个机构中审查了 23 项研究，包括一项试点随机对照试验。当不考虑数据重复时，自达芬奇机器人引入临床实践以来，共发表了 452 例机器人辅助腹腔镜前切除术和 60 例机器人辅助腹腔镜腹会阴直肠切除术。达芬奇机器人辅助全直肠系膜切除术的可行性得到了证实，对于直肠癌切除的肿瘤学结果也具有可比性。机器人手术的使用降低了开放转换率和住院时间，这一点得到了强调，但还需要进一步的试验来证实这两个发现。由于缺乏该领域的重点试验，因此无法确认使用达芬奇机器人是否具有功能优势。
