Jayakumar Shruti, Nardini Marco, Papoulidis Pavlos, Dunning Joel
Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, United Kingdom.
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):1049-1050. doi: 10.1093/icvts/ivx436.
We present the case of a 74-year-old man with Stage IIa pulmonary adenocarcinoma, for which he underwent a robotic right middle lobectomy. A 4-armed, 5-port approach was used. Four intercostal ports were created above the ninth rib using the Cerfolio's technique. The subxiphoid port was created in the midline, 5 cm down from the xiphisternum. The robot offers higher image quality, depth perception and improved articulation of the instruments, allowing for more accurate dissection and stitching. The usage of a subxiphoid utility port reduces the clashing between instruments, offers a good angle for stapling and provides a direct view of the instruments entering into the chest. Specimen removal through the subxiphoid port may reduce postoperative pain and enhance patient recovery. The use of the subxiphoid approach as a utility port for robotic surgery is promising and may be a suitable replacement for the traditional utility port.
我们报告一例74岁患有IIa期肺腺癌的男性病例，他接受了机器人辅助右肺中叶切除术。采用四臂、五端口入路。使用Cerfolio技术在第九肋上方创建了四个肋间端口。剑突下端口在中线，从剑突向下5厘米处创建。机器人提供更高的图像质量、深度感知和更好的器械关节活动度，从而实现更精确的解剖和缝合。使用剑突下实用端口可减少器械之间的碰撞，为吻合器提供良好角度，并能直接看到进入胸腔的器械。通过剑突下端口取出标本可减轻术后疼痛并促进患者恢复。将剑突下入路用作机器人手术的实用端口很有前景，可能是传统实用端口的合适替代方案。
