Mushtaq Harith H, Shah Shinil K, Agarwal Amit K
General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.331, Houston, TX, 77030, USA.
Minimally Invasive and Elective General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA.
Curr Gastroenterol Rep. 2019 Mar 6;21(3):11. doi: 10.1007/s11894-019-0676-7.
Despite the growth in laparoscopic surgery, comparable oncological outcomes, and reduced complication rates, the majority of colorectal surgery is still performed via an open approach. Reasons for this may include technical difficulties associated with operating in narrow spaces such as in the pelvis and inadequate experience. Robotic surgery provides potential solutions to some of these challenges. This review will summarize the state of the literature regarding robotic colorectal surgery.
The most consistent benefit of robotic surgery is decreasing operative conversions, specifically in rectal cancer. In partial colectomies, there is evidence to support quicker return to bowel function. Oncologic outcomes compared to the laparoscopic approach are equivalent. Robotic surgery provides solutions to the challenges posed by laparoscopy, including wristed instruments, ease of intracorporeal suturing, and ergonomic advantages. Randomized trials to evaluate peri-operative outcomes will be important. If robotics is able to facilitate conversion of open colectomies to their minimally invasive equivalent, robotics may end up proving to be advantageous in the peri-operative and post-operative period. Continued studies are warranted.
尽管腹腔镜手术不断发展，肿瘤学治疗效果相当且并发症发生率降低，但大多数结直肠手术仍通过开放手术进行。其原因可能包括在骨盆等狭窄空间操作的技术困难以及经验不足。机器人手术为其中一些挑战提供了潜在解决方案。本综述将总结关于机器人结直肠手术的文献现状。
机器人手术最一致的益处是减少手术中转率，尤其是在直肠癌手术中。在部分结肠切除术中，有证据支持肠道功能恢复更快。与腹腔镜手术相比，肿瘤学治疗效果相当。机器人手术解决了腹腔镜手术带来的挑战，包括腕式器械、体内缝合的便利性以及人体工程学优势。评估围手术期结果的随机试验将很重要。如果机器人技术能够促进开放结肠切除术向微创等效手术的转变，那么机器人技术最终可能在围手术期和术后被证明是有利的。有必要继续进行研究。
