Wang Xian-Qiang, Xu Shu-Juan, Wang Zheng, Xiao Yuan-Hong, Xu Jing, Wang Zhen-Dong, Chen Di-Xiang
Department of Pediatrics, PLA General Hospital, Beijing 100853, China.
Center of Anesthesia and Operation, PLA General Hospital, Beijing 100853, China.
World J Clin Cases. 2018 Jul 16;6(7):143-149. doi: 10.12998/wjcc.v6.i7.143.
Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3 robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3 (0.3-15.9) years; the male-to-female ratio was 1:3.5 (19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9% (79/86). The average total operation time was 426 (180-520) min, the operation time on the machine was 302 (120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of robotic-assisted choledochocystectomy was 8.8 d. Eight patients had biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons' experience, robotic surgery may become a new trend in this surgical procedure.
我们的论文描述了完全由达芬奇机器人系统实施小儿胆总管囊肿切除术的关键手术要点。我院为一名女童成功实施了胆总管囊肿切除术，且无任何并发症。随后进行了系统的文献回顾，以探讨肠道手术及肠吻合方法、3个机器人手臂的使用、与开放手术和腹腔镜手术相比的手术安全性及优势。我们系统回顾了机器人手术治疗小儿胆总管囊肿切除术。共纳入国内外8篇报道，总计86例患者，平均年龄6.3（0.3 - 15.9）岁；男女比例为1:3.5（19:67）。7例患者中转开腹手术，手术成功率为91.9%（79/86）。平均总手术时间为426（180 - 520）分钟，机器上的操作时间为302（120 - 418）分钟，11例使用3号手臂，其余主要采用缝吊技术悬吊胃壁和肝脏。47例患者行拖出式肠管及肠吻合术，39例患者行完全机器人肠道手术及肠吻合术。机器人辅助胆总管囊肿切除术的住院时间为8.8天。8例患者出现胆瘘，均经保守治疗及持续观察治愈。1例患者出现吻合口狭窄，1例患者出现伤口裂开，均经手术治愈。完全机器人手术联合Roux-en-Y肝空肠吻合术治疗小儿胆总管囊肿是安全可行的。初步经验表明，这种手术方式比传统内镜视野更清晰，操作更灵活，手术更精准，损伤更小。随着技术的进步和外科医生经验的积累，机器人手术可能成为该手术方式的新趋势。
