Perez D, Woestemeier A, Ghadban T, Stein H, Gomez-Ruiz M, Izbicki J R, Soh Min B
Abteilung für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Abteilung für Klinische Entwicklung, Intuitive Surgical, Sunnyvale, CA, USA.
Chirurg. 2019 Dec;90(12):1003-1010. doi: 10.1007/s00104-019-0973-6.
Performing colorectal surgery with previous da Vinci system generations presented some limitations that caused uncertainty for surgeons as they began to apply robotic technologies. The da Vinci Xi system is designed to overcome these limitations and to enable multiquadrant colorectal surgery.
The design concept of the da Vinci Xi system and the standardized access for colorectal surgery are explained.
The da Vinci Xi system applies an overhead boom that maximizes the arm workspace, minimizes interference and makes the port placement universal for standardized access. Colorectal approaches have been validated in numerous cadaver models confirming the reproducibility of the standardized access.
Standardized access with a straight-line port placement is possible in all colorectal applications. For right-sided hemicolectomy, a transverse abdominal approach as well as a suprapubic port placement are possible. Utilizing the same principles, left-sided colectomy, sigmoid colectomy and low anterior resections can be performed. Proctocolectomy is enabled through boom rotation and a second docking. Only minor arm-to-arm interferences occurred and were easily manageable by the bedside assistant. None of the approaches required rearrangement of the patient cart or swapping arms to different port locations.
The da Vinci Xi system enables a standardized access for colorectal surgery through a universal straight-line port placement. Learning this standard principle once enables the surgeon to apply it to all colorectal surgeries and shorten the learning curve as well as minimizing stress for both novices and experienced robotic surgeons learning a new surgical robotic platform.
使用早期几代达芬奇系统进行结直肠手术存在一些局限性，这使得外科医生在开始应用机器人技术时感到不确定。达芬奇Xi系统旨在克服这些局限性，并实现多象限结直肠手术。
解释达芬奇Xi系统的设计理念以及结直肠手术的标准化入路。
达芬奇Xi系统采用高架悬臂，可最大化手臂工作空间，减少干扰，并使端口放置通用化以实现标准化入路。结直肠手术入路已在众多尸体模型中得到验证，证实了标准化入路的可重复性。
在所有结直肠手术应用中，采用直线端口放置实现标准化入路是可行的。对于右侧半结肠切除术，可以采用横向腹部入路以及耻骨上端口放置。利用相同的原则，可以进行左侧结肠切除术、乙状结肠切除术和低位前切除术。通过悬臂旋转和第二次对接可进行全直肠系膜切除术。仅发生了轻微的手臂间干扰，床边助手很容易处理。所有入路均无需重新安排患者推车或更换手臂到不同端口位置。
达芬奇Xi系统通过通用的直线端口放置实现了结直肠手术的标准化入路。一旦掌握这一标准原则，外科医生就能将其应用于所有结直肠手术，缩短学习曲线，并将新手和经验丰富的机器人外科医生学习新手术机器人平台时的压力降至最低。
