新型手术机器人系统辅助下耳后入路机器人甲状腺切除术的最新进展

Recent progress of retroauricular robotic thyroidectomy with the new surgical robotic system.

作者信息

Byeon Hyung Kwon, Holsinger F Christopher, Duvvuri Umamaheswar, Kim Da Hee, Park Jae Hong, Chang Estelle, Kim Se-Heon, Koh Yoon Woo

机构信息

Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul.

Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.

出版信息

Laryngoscope. 2018 Jul;128(7):1730-1737. doi: 10.1002/lary.26938. Epub 2017 Oct 25.

DOI:10.1002/lary.26938

PMID:29068059

Abstract

OBJECTIVE

Previously, we have reported the feasibility of retroauricular (RA) robotic thyroidectomy. Despite its promising surgical outcomes, there were certain intrinsic mechanical limitations inherent to the da Vinci Si System (Intuitive Surgical, Sunnyvale, California, U.S.A.). Since the advent of an upgraded model, the Xi System (Intuitive Surgical), we have actively incorporated the new model into performing RA thyroidectomy. Here, we intend to verify the feasibility of RA robotic thyroidectomy using the new da Vinci Xi System (Intuitive Surgical) with comparison of the former Si-applied surgery (Intuitive Surgical).

STUDY DESIGN

Comparative analysis.

METHODS

There were total 165 consecutive patients who received RA robotic thyroidectomy from January 2013 to February 2016. The patients were divided into two groups: Si group (n = 125) and Xi group (n = 40). Perioperative and treatment outcomes were compared and analyzed.

RESULTS

Compared with the previous system, new da Vinci Xi system (Intuitive Surgical) enabled insertion of an extra third robotic instrumental arm. Unlike the previous robotic surgical technique, the robotic dissection could be initiated immediately after the establishment of working space and the resulting total operation time could be significantly decreased. There was no difference in the surgical completeness, as confirmed by postoperative thyroglobulin levels. Additionally, flexed EndoWrist (Intuitive Surgical) instruments equipped with the Erbe (Erbe USA Inc., Marietta, Georgia, U.S.A.) system could be mounted, which further facilitated the operation. There were no significant differences in postoperative complications between the two groups.

CONCLUSION

The RA robotic thyroidectomy with the new Xi System (Intuitive Surgical) can greatly facilitate the robotic surgery with comparable or improved surgical outcomes. Its application is expected to open up a new era of robotic neck surgery.

LEVEL OF EVIDENCE

Laryngoscope, 128:1730-1737, 2018.

摘要

目的

此前，我们已报道了耳后（RA）机器人甲状腺切除术的可行性。尽管其手术效果良好，但达芬奇Si系统（直观外科手术公司，美国加利福尼亚州森尼韦尔市）存在一些固有的机械局限性。自升级版Xi系统（直观外科手术公司）问世以来，我们积极将新系统应用于RA甲状腺切除术。在此，我们旨在通过与之前应用Si系统的手术（直观外科手术公司）进行比较，验证使用新型达芬奇Xi系统（直观外科手术公司）进行RA机器人甲状腺切除术的可行性。

研究设计

对比分析。

方法

2013年1月至2016年2月期间，共有165例连续接受RA机器人甲状腺切除术的患者。患者分为两组：Si组（n = 125）和Xi组（n = 40）。对围手术期和治疗结果进行比较和分析。

结果

与之前的系统相比，新型达芬奇Xi系统（直观外科手术公司）能够额外插入第三个机器人器械臂。与之前的机器人手术技术不同，在建立工作空间后可立即开始机器人解剖，从而显著缩短总手术时间。术后甲状腺球蛋白水平证实，手术完整性没有差异。此外，配备爱尔博（美国爱尔博公司，美国佐治亚州玛丽埃塔市）系统的可弯曲腕部（直观外科手术公司）器械可以安装，这进一步便于手术操作。两组术后并发症无显著差异。