Chen Qi-Yue, Zhong Qing, Zheng Chao-Hui, Huang Chang-Ming
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
Surg Oncol. 2019 Mar;28:67-68. doi: 10.1016/j.suronc.2018.11.014. Epub 2018 Nov 14.
Robotic systems recently have been introduced to overcome technical limitations of conventional laparoscopic gastrectomy, especially for complex procedures [1]. We developed a set of procedural operation steps for robotic spleen-preserving splenic hilar lymphadenectomy, which is difficult and recommended in D2 lymph node (LN) dissection during total gastrectomy [2-4].
The robotic operative procedures of splenic hilar lymphadenectomy using the da Vinci Si system were demonstrated in a step-by-step manner, with technical tips for each step, in the video clip. The above procedures were performed on 40 consecutive patients with stage cT2-3 proximal gastric cancer between July 2016 and September 2017. The learning curve was analyzed based on the cumulative sum method (CUSUM).
The mean age and body mass index of patients were 55.3 ± 10.4 years (range 29-78) and 23.0 ± 2.7 kg/m (range 15.4-28.4), respectively. All spleen-preserving surgeries were successfully performed without open or laparoscopy conversion. Mean operation time of splenic hilar lymphadenectomy was 20.3 ± 6.4 min (range 13.3-46.3); mean blood loss was 13.7 ± 5.3 ml (range 8.0-40.0). The overall average of 38.8 ± 13.1 LNs (range 19-81) was retrieved, including a mean 3.3 ± 1.4 (range 0-8) splenic hilar area LNs, with a 10% (4/40) metastatic rate. No immediate postoperative mortality was observed. 6 patients (15.0%) experienced a complication after surgery; the operation-related complications consisted of one wound complications, one abdominal infection, and one anastomosis leakage. At a median follow-up of 12 months, one patient had experienced lung metastasis. According to the CUSUM, the cut-off point of splenic hilar LN dissection time and blood loss were 15th and 20th cases, respectively.
Robotic surgery can improve the quality of surgery and promote the D2 LN dissection. This procedure is feasible and simplifies complicated splenic hilar lymphadenectomy.
机器人系统最近被引入以克服传统腹腔镜胃切除术的技术局限性，尤其是对于复杂手术[1]。我们制定了一套机器人保留脾脏的脾门淋巴结清扫术的手术操作步骤，该手术在全胃切除术中的D2淋巴结（LN）清扫中难度较大但被推荐[2-4]。
使用达芬奇Si系统进行脾门淋巴结清扫术的机器人手术步骤在视频片段中一步一步地展示，并针对每个步骤给出技术要点。上述手术于2016年7月至2017年9月连续对40例cT2-3期近端胃癌患者进行。基于累积和方法（CUSUM）分析学习曲线。
患者的平均年龄和体重指数分别为55.3±10.4岁（范围29-78岁）和23.0±2.7kg/m²（范围15.4-28.4）。所有保留脾脏的手术均成功完成，无需转为开放手术或腹腔镜手术。脾门淋巴结清扫术的平均手术时间为20.3±6.4分钟（范围13.3-46.3）；平均失血量为13.7±5.3毫升（范围8.0-40.0）。总共平均取出38.8±13.1个淋巴结（范围19-81个），其中脾门区域平均取出3.3±1.4个淋巴结（范围0-8个），转移率为10%（4/40）。未观察到术后即刻死亡。6例患者（15.0%）术后出现并发症；与手术相关的并发症包括1例伤口并发症、1例腹腔感染和1例吻合口漏。中位随访12个月时，1例患者发生肺转移。根据CUSUM分析，脾门淋巴结清扫时间和失血量的分界点分别为第15例和第20例。
机器人手术可提高手术质量并促进D2淋巴结清扫。该手术可行且简化了复杂的脾门淋巴结清扫术。
