单阶段机器人全直肠系膜切除术——一种逐步推进的方法。
Single stage robotic total mesorectal excision-a stepwise approach.
作者信息
Priatno Eko, Kim Seon Hahn
机构信息
Department of Surgery, Puri Indah Hospital, Jakarta, Indonesia.
Colorectal Division, Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
出版信息
J Vis Surg. 2015 Dec 11;1:24. doi: 10.3978/j.issn.2221-2965.2015.12.02. eCollection 2015.
BACKGROUND
The totally robotic procedure was traditionally described as a two-stage technique or a three-stage technique. The number of stages corresponds to the number of movements of the robotic cart. In this video article, we develop a stepwise approach video of robotic total mesorectal excision (TME) for mid rectal cancer (the surgery was performed by SHK) using a da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) at Korea University Anam Hospital, Seoul.
METHODS
After the induction of general anesthesia, the patient is placed in a modified lithotomy position. Six ports are used, including one 12-mm camera port, four 8-mm robotic working ports, and one 5-mm port for the assistant. The patient is tilted to the right side and placed in the Trendelenburg position. The small-bowel loops retracted out from the pelvic cavity to the right upper quadrant (RUQ) to expose the inferior mesenteric artery (IMA). The surgery is divided into three phases: (I) abdominal phase: vascular ligation, and sigmoid colon to splenic flexure mobilization; (II) pelvic dissection phase; and (III) rectal reconstruction phase. Mesorectal clearing was done at the level of rectal transection line (1-2 cm from distal tumor margin), then the rectum was transected with robotic stapler. Once this step is finished, the robotic arms are undocked and the cart is moved away from the patient. The remaining steps are performed in a conventional laparoscopic method.
RESULTS
Robotic TME was performed in a 56-year-old man with an endoscopically define rectal mass. The lesion was moderately differentiated adenocarcinoma, 8 cm from the anal verge (AV). The rectal mass was managed with single stage robotic TME. The operative time was 160 minutes and the patient was discharge on post operative day 10. Final pathology revealed moderately differentiated adenocarcinoma.
CONCLUSIONS
Single stage robotic TME was efficient and feasible technique for mid rectal cancer resection.
背景
传统上，全机器人手术被描述为两阶段技术或三阶段技术。阶段数与机器人手术台车的移动次数相对应。在这篇视频文章中，我们展示了在韩国首尔大学峨山医院，使用达芬奇Si HD手术系统（直观外科公司，美国加利福尼亚州桑尼维尔），对一名中直肠癌患者进行机器人全直肠系膜切除术（TME）的逐步操作视频（手术由SHK完成）。
方法
全身麻醉诱导后，患者取改良截石位。使用六个端口，包括一个12毫米的摄像端口、四个8毫米的机器人操作端口和一个5毫米的助手端口。患者向右侧倾斜并置于头低脚高位。将小肠袢从盆腔牵出至右上腹（RUQ）以暴露肠系膜下动脉（IMA）。手术分为三个阶段：（I）腹部阶段：血管结扎，以及乙状结肠至脾曲的游离；（II）盆腔解剖阶段；（III）直肠重建阶段。在直肠横断水平（距肿瘤远端边缘1 - 2厘米）进行直肠系膜清扫，然后用机器人吻合器切断直肠。这一步完成后，将机器人手臂拆卸，手术台车移开患者。其余步骤采用传统腹腔镜方法进行。
结果
对一名56岁患有内镜确诊直肠肿物的男性患者进行了机器人TME手术。病变为中度分化腺癌，距肛缘（AV）8厘米。该直肠肿物通过单阶段机器人TME进行处理。手术时间为160分钟，患者术后第10天出院。最终病理显示为中度分化腺癌。
结论
单阶段机器人TME是中直肠癌切除的一种有效且可行的技术。
Zotero 插件