Guadagni Simone, Di Franco Gregorio, Gianardi Desirée, Palmeri Matteo, Ceccarelli Cristina, Bianchini Matteo, Furbetta Niccolò, Caprili Giovanni, D'Isidoro Cristiano, Moglia Andrea, Melfi Franca, Buccianti Piero, Mosca Franco, Morelli Luca
1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy.
2 General Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
J Laparoendosc Adv Surg Tech A. 2018 Dec;28(12):1422-1427. doi: 10.1089/lap.2018.0218. Epub 2018 Jun 19.
A new robotic stapler for the da Vinci Xi is directly controlled by the surgeon at the console and equipped with EndoWrist technology. We evaluated operative and short-term results of the first patients who underwent anterior rectal resection for cancer with the da Vinci Xi and new staplers, and compared the results with those of a comparable group treated with traditional laparoscopic staplers. From December 2015 to December 2017, 25 patients underwent anterior rectal resection for cancer with robotic EndoWrist staplers (EndoWrist group). Using a case-control method, we compared the results with those of a similar group of patients treated with the same system and a traditional laparoscopic endostapler, controlled by a bedside assistant (Control group). No conversions to laparoscopy or laparotomy were observed, in either group. The mean number of charges was 2.1 ± 0.2 in the EndoWrist group versus 2.7 ± 0.7 in the Control group ( = .0004). The other perioperative results were comparable. During follow-up, the incidence of anastomotic fistula in a contrast enema study was higher in the Control group, although the difference was not statistically significant (two leaks versus two leaks in EndoWrist group; = .8). The interval between rectal resection and stoma closure was shorter in the EndoWrist group (3.4 ± 2.5 versus 4.2 ± 2.9 months in the Control group; = .2), although the difference was not significant. Our experience suggests that the new robotic staplers simplify transection, which could reduce the average number of stapler firings used during rectal resection and could decrease the incidence of anastomotic leakage. These findings require confirmation in larger studies.
一种用于达芬奇Xi手术系统的新型机器人吻合器，由外科医生在控制台直接控制，并配备了EndoWrist技术。我们评估了首批使用达芬奇Xi手术系统和新型吻合器进行直肠癌前切除术患者的手术效果和短期结果，并将结果与使用传统腹腔镜吻合器治疗的对照组进行比较。2015年12月至2017年12月，25例患者使用机器人EndoWrist吻合器进行了直肠癌前切除术（EndoWrist组）。采用病例对照法，我们将结果与另一组使用相同系统和传统腹腔镜腔内吻合器、由床边助手控制的类似患者（对照组）进行比较。两组均未观察到转为腹腔镜手术或开腹手术的情况。EndoWrist组的平均吻合次数为2.1±0.2次，而对照组为2.7±0.7次（P = 0.0004）。其他围手术期结果相当。在随访期间，对照组在造影剂灌肠研究中吻合口瘘的发生率较高，尽管差异无统计学意义（EndoWrist组有2例渗漏，对照组有2例渗漏；P = 0.8）。EndoWrist组直肠切除与造口关闭之间的间隔较短（3.4±2.5个月，对照组为4.2±2.9个月；P = 0.2），尽管差异不显著。我们的经验表明，新型机器人吻合器简化了横断操作，这可能会减少直肠癌切除术中使用的吻合器平均击发次数，并可能降低吻合口漏的发生率。这些发现需要在更大规模的研究中得到证实。
