Sian Tanvir Singh, Tierney G M, Park H, Lund J N, Speake W J, Hurst N G, Al Chalabi H, Smith K J, Tou S
Department of Colorectal Surgery, Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, UK.
Division of Health Sciences, University of Nottingham, School of Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK.
J Robot Surg. 2018 Jun;12(2):271-275. doi: 10.1007/s11701-017-0728-7. Epub 2017 Jul 18.
A background in minimally invasive colorectal surgery (MICS) has been thought to be essential prior to robotic-assisted colorectal surgery (RACS). Our aim was to determine whether MICS is essential prior to starting RACS training based on results from our initial experience with RACS. Two surgeons from our centre received robotic training through the European Academy of Robotic Colorectal Surgery (EARCS). One surgeon had no prior formal MICS training. We reviewed the first 30 consecutive robotic colorectal procedures from a prospectively maintained database between November 2014 and January 2016 at our institution. Fourteen patients were male. Median age was 64.5 years (range 36-82) and BMI was 27.5 (range 20-32.5). Twelve procedures (40%) were performed by the non-MICS-trained surgeon: ten high anterior resections (one conversion), one low anterior resection and one abdomino-perineal resection of rectum (APER). The MICS-trained surgeon performed nine high and four low anterior resections, one APER and in addition three right hemicolectomies and one abdominal suture rectopexy. There were no intra-operative complications and two patients required re-operation. Median post-operative stay was five days (range 1-26). There were two 30-day re-admissions. All oncological resections had clear margins and median node harvest was 18 (range 9-39). Our case series demonstrates that a background in MICS is not essential prior to starting RACS training. Not having prior MICS training should not discourage surgeons from considering applying for a robotic training programme. Safe and successful robotic colorectal services can be established after completing a formal structured robotic training programme.
人们一直认为，在开展机器人辅助结直肠手术（RACS）之前，具备微创结直肠手术（MICS）背景至关重要。我们的目的是根据我们在RACS方面的初步经验结果，确定在开始RACS培训之前，MICS是否必不可少。我们中心的两位外科医生通过欧洲机器人结直肠外科学会（EARCS）接受了机器人培训。其中一位外科医生之前没有接受过正规的MICS培训。我们回顾了2014年11月至2016年1月期间在我们机构前瞻性维护的数据库中连续进行的前30例机器人结直肠手术。14例患者为男性。中位年龄为64.5岁（范围36 - 82岁），体重指数为27.5（范围20 - 32.5）。12例手术（40%）由未接受MICS培训的外科医生完成：10例高位前切除术（1例中转开腹）、1例低位前切除术和1例直肠腹会阴联合切除术（APER）。接受MICS培训的外科医生进行了9例高位和4例低位前切除术、1例APER，此外还进行了3例右半结肠切除术和1例腹部缝合直肠固定术。术中无并发症发生，2例患者需要再次手术。中位术后住院时间为五天（范围1 - 26天）。有2例患者在30天内再次入院。所有肿瘤切除术切缘均清晰，中位淋巴结清扫数为18个（范围9 - 39个）。我们的病例系列表明，在开始RACS培训之前，MICS背景并非必不可少。没有先前的MICS培训不应阻碍外科医生考虑申请机器人培训项目。完成正式的结构化机器人培训项目后，可以建立安全、成功的机器人结直肠手术服务。
