Xu Pingping, Xu Jianmin
Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jun 25;20(6):606-609.
Robotic surgical system has been widely applied in sphincter-preserving surgery for low rectal cancer with the advantages of clear 3D images and stably flexile manipulation. Its application principle includes radical resection of tumor and complete preservation of function. The main operation procedures of robotic surgical system in sphincter-preserving surgery for low rectal cancer are as follows: (1) Anterior resection of low rectal cancer: It is safe and feasible and has obvious advantages in observation of pelvic nerves, dissociation of presacral and sacral side, and high rate of sphincter-preserving, while the improvement of postoperative recovery and long-term survival needs to be verified by further large sample researches. (2) Per anus intersphincteric resection (ISR): It is mainly applied in T1 and T2 stage tumors with 2 cm distance from tumor low margin to anal edge after dissociation of mesorectum. The greater difficulty of manipulation is found in ISR, while robotic surgical system can complete the intersphincteric resection by transabdominal approach, but anal function may be affected with the possibility of feces spillage at night, so robotic ISR is now still in exploration stage. (3) Transanal everted pull-through resection (Welch resection): Associated application of this operation is rarely reported at home and abroad. Our department has completed 51 robotic procedures of Welch resection till March 2017. Welch resection is successfully performed in all the patients. The short-term clinical outcomes are quite satisfactory and long-term survival is followed up. We think that this procedure is safe and feasible under the strict mastering of indications. Owing to special manipulation advantages of quickly precise dissociation, cutting and anastomosis in small pelvic space, when compared to laparoscopic surgery, robotic surgical system has higher sphincter-preserving rate for low rectal cancer, however, no other advantages are found. We believe that with the development of surgical instruments and ongoing of large sample studies, robotic surgical system will play a more important role in the treatment of low rectal cancer.
机器人手术系统凭借清晰的三维图像和稳定灵活的操作优势，已在低位直肠癌保肛手术中得到广泛应用。其应用原则包括肿瘤的根治性切除和功能的完全保留。机器人手术系统在低位直肠癌保肛手术中的主要操作步骤如下：（1）低位直肠癌前切除术：该手术安全可行，在盆腔神经观察、骶前和骶侧游离以及保肛率方面具有明显优势，然而术后恢复及长期生存的改善情况尚需进一步大样本研究验证。（2）经肛门括约肌间切除术（ISR）：主要适用于直肠系膜游离后肿瘤下缘距肛缘2 cm的T1和T2期肿瘤。ISR操作难度较大，而机器人手术系统可经腹途径完成括约肌间切除，但可能影响肛门功能，存在夜间粪便溢出的可能，因此机器人ISR目前仍处于探索阶段。（3）经肛门外翻拖出切除术（Welch切除术）：国内外关于该手术联合应用的报道较少。截至2017年3月，我科已完成51例机器人Welch切除手术。所有患者均成功实施了Welch切除术。短期临床效果相当满意，目前正在对长期生存情况进行随访。我们认为，在严格掌握适应证的情况下，该手术安全可行。由于在小盆腔空间中具有快速精确游离、切割和吻合的特殊操作优势，与腹腔镜手术相比，机器人手术系统在低位直肠癌保肛率方面更高，但未发现其他优势。我们相信，随着手术器械的发展以及大样本研究的持续进行，机器人手术系统将在低位直肠癌的治疗中发挥更重要的作用。
