Diez Del Val Ismael, Martinez Blazquez Cándido, Loureiro Gonzalez Carlos, Vitores Lopez Jose Maria, Sierra Esteban Valentin, Barrenetxea Asua Julen, Del Hoyo Aretxabala Izaskun, Perez de Villarreal Patricia, Bilbao Axpe Jose Esteban, Mendez Martin Jaime Jesus
Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain.
J Robot Surg. 2014 Jun;8(2):111-8. doi: 10.1007/s11701-013-0435-y. Epub 2013 Sep 14.
Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46-65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks-two cervical and one thoracic-managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3-7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.
机器人辅助手术克服了传统腹腔镜手术的一些局限性。我们介绍了在两个专门从事胃食管手术的外科单元中的经验和教训。2009年6月至2013年1月，我们进行了130例机器人辅助胃食管手术，包括nissen胃底折叠术（29例）、食管旁疝修补术（18例）、抗反流手术失败后的再次手术（11例）、食管切除术（19例）、次全胃切除术（5例）或楔形胃切除术（4例）、贲门失弛缓症的Heller肌切开术（22例）、病态肥胖的胃旁路手术（12例）、胸腔镜下平滑肌瘤切除术（4例）、Morgagni疝修补术（3例）、食管下三分之一憩室切除术（1例）以及两项诊断性手术。患者中有80名男性和50名女性，中位年龄为54岁（四分位间距：46 - 65岁）。10名患者（7.7%）出现严重术后并发症：8例发生在食管切除术后（3例漏出——2例颈部和1例胸部，保守处理）、1例吻合器故障、1例乳糜胸、1例胃移位至胸腔、1例胆汁性腹膜炎以及1例患者出现短暂性心室运动障碍。1例再次手术因穿刺孔出血需要再次手术，1例患者在巨大食管旁疝修补术后死于肺部并发症；因此，30天死亡率为0.8%。有6例选择性和1例因出血导致的被迫中转手术，所以总中转率为5.4%。中位住院时间为4天（四分位间距3 - 7天）。机器人辅助胃食管手术是可行且安全的，可应用于大多数常见手术。对于Heller肌切开术、大型食管旁疝、再次抗反流手术、经裂孔解剖以及手工缝合胸内吻合术似乎具有特别价值。
