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使用和不使用新型达芬奇手术台运动的机器人结直肠切除术:一项病例匹配研究。

Robotic Colorectal Resection With and Without the Use of the New Da Vinci Table Motion: A Case-Matched Study.

作者信息

Palmeri Matteo, Gianardi Desirée, Guadagni Simone, Di Franco Gregorio, Bastiani Luca, Furbetta Niccolò, Simoncini Tommaso, Zirafa Cristina, Melfi Franca, Buccianti Piero, Moglia Andrea, Cuschieri Alfred, Mosca Franco, Morelli Luca

机构信息

1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy.

2 Institute of Clinical Physiology, National Council of Research, Pisa, Italy.

出版信息

Surg Innov. 2018 Jun;25(3):251-257. doi: 10.1177/1553350618765540. Epub 2018 Mar 26.

Abstract

BACKGROUND

The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM.

METHODS

Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group).

RESULTS

Overall robotic operative time was shorter in the Xi-dVTM group ( P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group ( P = .024).

CONCLUSIONS

In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.

摘要

背景

达芬奇手术台运动(dVTM)是一种新设备,可在器械置于患者腹腔内且不脱离机器人的情况下对患者进行重新定位。本研究旨在比较使用或不使用dVTM的达芬奇Xi系统进行结直肠癌手术患者的手术及短期预后。

方法

2015年5月至2015年10月期间,在我们中心有10例患者使用dVTM进行了机器人辅助结直肠癌切除术(Xi-dVTM组)。采用病例对照方法(倾向评分法创建1:2匹配对),将其与一组未使用dVTM设备进行机器人辅助结直肠癌手术的类似患者(仅Xi组)比较术中及短期临床结果。

结果

Xi-dVTM组的总体机器人手术时间较短(P = 0.04)。所有Xi-dVTM病例均完全通过机器人完成手术,而仅Xi组有2例因肿瘤体积大且暴露困难而需转为开放手术。仅Xi组的术后医疗并发症更高(P = 0.024)。

结论

在这一初步经验中,在结直肠癌手术中使用新型dVTM与达芬奇Xi系统,通过克服患者固定体位的局限性,优化了工作流程,改善了术野暴露。需要更多患者参与的进一步研究来证实dVTM-达芬奇Xi机器人辅助结直肠癌手术的这些益处。

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