Lim Seung Hyun, Lee Hae Min, Son Taeil, Hyung Woo Jin, Kim Hyoung-Il
Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea;; Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea.
Transl Gastroenterol Hepatol. 2016 Apr 7;1:28. doi: 10.21037/tgh.2016.03.21. eCollection 2016.
Surgical techniques have evolved tremendously over this past century. To maximize the efficacy and minimize the invasiveness of laparoscopic surgery, researchers have sought to implement wider application of robotics. Nevertheless, both optimism without sound evidence and fear of new technology obscure the appropriate uses of robotic surgery. In the present review, we attempted to provide a balanced perspective on the current state of robotic gastrectomy, outlining evidence and opportunities for the use thereof. Although evidence is limited, the use of robotics is feasible for gastric cancer surgery, and less than 10 cases of robotic surgery are needed to become proficient therein. Compared to the clinical impact of laparoscopy on gastric cancer surgery, the additional benefits of robotic surgery to patients seem to be limited. Despite additional costs and longer surgeries, robotic surgery reportedly does not offer surgical outcomes superior to those for laparoscopic surgery, according to a recent multicenter study. Meanwhile, however, our in-depth review of retrospective and prospective reports revealed that robots could expand the indications of minimally invasive gastrectomy for patients requiring total gastrectomy and D2 lymph node dissection. Moreover, we found that robotic gastrectomy is associated with a higher number of retrieved lymph nodes, less bleeding, fewer complications, and shorter hospital stay, compared to laparoscopic gastrectomy. Accordingly, new surgical approaches using advanced technologies, such as near infrared detectors, the Tilepro multi-input display, dual consoles, and the Single-Site system, are under investigation. In conclusion, measuring the additional benefits of robotic over laparoscopic surgery would be difficult and clinically insignificant. Thus, developing new surgical procedures that extend the benefits of conventional laparoscopic surgery to patients in whom minimally invasive surgery would not be possible is necessary to justify the greater use of robotic surgery.
在过去的一个世纪里，外科技术有了巨大的发展。为了最大限度地提高腹腔镜手术的疗效并减少其侵入性，研究人员一直在寻求更广泛地应用机器人技术。然而，缺乏可靠证据的乐观态度和对新技术的恐惧掩盖了机器人手术的合理应用。在本综述中，我们试图对机器人胃癌切除术的现状提供一个平衡的观点，概述其使用的证据和机会。虽然证据有限，但机器人技术在胃癌手术中是可行的，熟练掌握该技术只需不到10例手术经验。与腹腔镜手术对胃癌手术的临床影响相比，机器人手术给患者带来的额外益处似乎有限。根据最近一项多中心研究，尽管机器人手术成本更高、手术时间更长，但据报道其手术效果并不优于腹腔镜手术。然而，与此同时，我们对回顾性和前瞻性报告的深入审查发现，对于需要全胃切除和D2淋巴结清扫的患者，机器人技术可以扩大微创胃切除术的适应症。此外，我们发现与腹腔镜胃切除术相比，机器人胃切除术能获取更多的淋巴结、出血更少、并发症更少且住院时间更短。因此，使用先进技术（如近红外探测器、Tilepro多输入显示器、双控制台和单孔系统）的新手术方法正在研究中。总之，衡量机器人手术相对于腹腔镜手术的额外益处将很困难且在临床上意义不大。因此，开发新的手术方法，将传统腹腔镜手术的益处扩展到无法进行微创手术的患者，对于证明更广泛使用机器人手术的合理性是必要的。
