Mangano Alberto, Bustos Roberto, Fernandes Eduardo, Masrur Mario, Valle Valentina, Aguiluz Gabriela, Giulianotti Pier C
Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA -
Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Minerva Chir. 2020 Feb;75(1):43-50. doi: 10.23736/S0026-4733.18.07815-X. Epub 2018 May 29.
Minimally invasive surgery (MIS) has produced an important improvement in terms of peri-operative outcomes. Laparoscopic colorectal surgery presents comparable outcomes vs. open approach from an oncological standpoint. However, there are some technical challenges/hurdles that laparoscopy may have. Worldwide there are still too many colonic/rectal operations carried out by the open approach. The robotic technology may be useful in solving some of the potential laparoscopic issues and potentially it may increase the number of procedures performed in a minimally invasive way. This is a description of our standardized operative technique for Robotic Right Colonic Resection. Conceivably, this manuscript may be useful to collect more repeatable data in the future. Moreover, it might be a guide to learn the robotic technique and also for the expert surgeons as an additional tool which they may find useful during their teaching activity. In this manuscript, taking advantage of the long and extensive expertise in minimally invasive colorectal resections, connected to a robotic experience started by Giulianotti in October 2000, we present our standardized technique for the robotic right colonic resection. The currently available literature data have proven that robotic colorectal surgery is safe/feasible. From the literature data, and from our experience as well, we think that these are the following main points: 1) the right colectomy is often an operation which can be performed in a relatively simple way even with traditional laparoscopy. However, the robotic approach is easier to standardize and this operation is very useful from a teaching standpoint in order to master multiple robotic surgical skills (that can be applied in more complex colorectal operations); 2) the robotic surgery may increase the MIS penetrance in this field. 3) the robotic third arm (R3) is an important technical advantage which can potentially increase the range of surgical options available; 4) the robotic technology is relatively recent. Most of the available data are retrospective and there is literature heterogenity (this affects also the conclusions of the currently available meta-analysis results, which sometimes are conflicting); 5) we need more data from prospective randomized well-powered studies (with standardized technique). Achieving a standardized technical approach will be essential in robotic colorectal surgery.
微创手术（MIS）在围手术期结局方面取得了重要进展。从肿瘤学角度来看，腹腔镜结直肠手术与开放手术相比具有相当的结局。然而，腹腔镜手术可能存在一些技术挑战/障碍。在全球范围内，仍有太多的结肠/直肠手术采用开放手术方式进行。机器人技术可能有助于解决一些潜在的腹腔镜问题，并且有可能增加以微创方式进行的手术数量。本文描述了我们机器人辅助右半结肠切除术的标准化手术技术。可以想象，这篇手稿可能有助于在未来收集更多可重复的数据。此外，它可能是学习机器人技术的指南，对于专家外科医生来说，也是他们在教学活动中可能会发现有用的额外工具。在本文中，凭借在微创结直肠切除术中积累的长期广泛专业知识，结合朱利亚诺蒂于2000年10月开始的机器人手术经验，我们展示了机器人辅助右半结肠切除术的标准化技术。目前可得的文献数据已证明机器人结直肠手术是安全/可行的。从文献数据以及我们的经验来看，我们认为以下是主要要点：1）即使采用传统腹腔镜手术，右半结肠切除术通常也是一种可以以相对简单的方式进行的手术。然而，机器人手术方法更易于标准化，并且从教学角度来看，该手术对于掌握多种机器人手术技能（这些技能可应用于更复杂的结直肠手术）非常有用；2）机器人手术可能会提高该领域的微创手术普及率。3）机器人第三臂（R3）是一项重要的技术优势，有可能增加可用的手术选择范围；4）机器人技术相对较新。大多数现有数据是回顾性的，并且存在文献异质性（这也影响了当前可用的荟萃分析结果的结论，这些结论有时相互矛盾）；5）我们需要来自前瞻性随机、样本量充足且技术标准化的研究的更多数据。实现标准化的技术方法在机器人结直肠手术中将至关重要。
