Marks J H, Salem J F, Anderson B K, Josse J M, Schoonyoung H P
Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA.
The Colorectal Center at Lankenau Medical Center, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
Tech Coloproctol. 2020 Jan;24(1):57-63. doi: 10.1007/s10151-019-02129-0. Epub 2019 Dec 12.
The single-port daVinci robot is a new platform designed to facilitate single-incision surgeries. The objective of this study was to describe the first clinical experience in colorectal surgery using a novel single-port robotic system and report its feasibility and safety.
After Institutional Review Board approval was obtained and the study was registered with ClinicalTrials.gov, we performed single port robot-assisted left colectomy using the novel daVinci SP surgical system on two patients. The surgeries were completed through a single incision. The multichannel port accommodates a three-dimensional articulating camera and three double-jointed articulating instruments. The primary aim of this study was to report, for the first time in the USA, the technical feasibility of the procedure in the living human. The secondary aim was to report the outcomes including blood loss, number of incisions, number of dockings, docking time of the robot, incision length, operative time, console time, need for additional port and instrumentation, intraoperative complications, morbidity and mortality, time for tolerating diet, bowel function, and discharge.
Both surgeries were completed without conversion through a single incision, 4.0 and 4.5 cm in size. Estimated blood loss was less than 60 ml in both cases. The robot was docked two and three times. Mean time to dock was 13 min (range 3-33 min). There were no intraoperative complications, no morbidity or death. Discharges occurred on postoperative days 2 and 3.
Single-port robotic colectomy using the new robot is feasible and can be safely completed. The overall utility and functionality of the SP robot portends wide utilization and expansion of this technique. Careful development and analysis of the procedure outcomes, training, and cost will be necessary to properly advance the field.
单孔达芬奇机器人是为便于单切口手术而设计的新平台。本研究的目的是描述使用新型单孔机器人系统进行结直肠手术的首例临床经验，并报告其可行性和安全性。
在获得机构审查委员会批准并在ClinicalTrials.gov上注册该研究后，我们使用新型达芬奇SP手术系统对两名患者进行了单孔机器人辅助左半结肠切除术。手术通过单一切口完成。多通道端口可容纳一个三维关节式摄像头和三个双关节式操作器械。本研究的主要目的是首次在美国报告该手术在人体上的技术可行性。次要目的是报告手术结果，包括失血量、切口数量、对接次数、机器人对接时间、切口长度、手术时间、控制台操作时间、是否需要额外端口和器械、术中并发症、发病率和死亡率、饮食耐受时间、肠功能以及出院情况。
两台手术均通过大小分别为4.0厘米和4.5厘米的单一切口完成，未中转。两例患者的估计失血量均少于60毫升。机器人分别对接了两次和三次。平均对接时间为13分钟（范围3 - 33分钟）。术中无并发症，无发病或死亡情况。患者分别在术后第2天和第3天出院。
使用新型机器人进行单孔机器人结肠切除术是可行的，且能安全完成。SP机器人的整体实用性和功能预示着该技术将得到广泛应用和推广。为了推动该领域的发展，需要对手术结果、培训和成本进行仔细的研究和分析。
