Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University, 1306 Doonsan-dong, Daejeon, 302-799, Korea.
J Robot Surg. 2021 Apr;15(2):241-249. doi: 10.1007/s11701-020-01093-4. Epub 2020 Jun 6.
Although robotic single-site (RSS) surgery employing cross setup of semirigid instruments allows effective triangulation of instruments, it has some limitations in performing RSS transabdominal and transvaginal surgeries. We introduced the robotic glove port technique (RGPT) using parallel setup of endowristed rigid instruments in performing RSS transabdominal surgery and transvaginal surgery in July of 2017. Thirty-five patients underwent RSS surgery with RGPT. Twenty-one patients had RSS transabdominal reconstructive or fertility-preserving surgeries such as myomectomy (12 patients), adenomyomectomy (3 patients), and ovarian endometriosis cystectomy (6 patients). Fourteen patients underwent robotic transvaginal surgery for natural orifice transluminal endoscopic surgery (NOTES) hysterectomy. All procedures were successfully performed, and no postoperative complications were observed. In all patients, the median total operative time, console time, and docking time were 160 min (range 106-240), 120 min (range 65-180), and 10 min (range 4-25), respectively. There was no conversion to another type of surgery, such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. The findings showed that RSS surgery via the RGPT is safe and feasible, using the parallel setup of endowristed rigid instruments is easily performed on transvaginal routes and transabdominal routes. Therefore, this procedure may be an important complement to gynecologic surgeons' armamentarium in the field of robotic reconstructive or fertility-preserving surgeries such as myomectomy, adenomyomectomy, ovarian cystectomy, and transvaginal surgery for NOTES hysterectomy. Nevertheless, further prospective controlled studies are needed to determine its full clinical application.
虽然采用半刚性器械交叉设置的机器人单部位（RSS）手术允许有效地进行器械三角定位，但它在进行 RSS 经腹和经阴道手术时存在一些限制。我们于 2017 年 7 月引入了使用腕关节器械刚性仪器平行设置的机器人手套端口技术（RGPT），以进行 RSS 经腹手术和经阴道手术。35 名患者接受了 RGPT 辅助的 RSS 手术。21 名患者接受了 RSS 经腹重建或保留生育力手术，包括子宫肌瘤切除术（12 例）、子宫腺肌瘤切除术（3 例）和卵巢子宫内膜异位囊肿切除术（6 例）。14 名患者接受了机器人经阴道手术，用于自然腔道内镜手术（NOTES）子宫切除术。所有手术均成功完成，未观察到术后并发症。所有患者的中位总手术时间、控制台时间和对接时间分别为 160 分钟（范围 106-240 分钟）、120 分钟（范围 65-180 分钟）和 10 分钟（范围 4-25 分钟）。没有转换为其他类型的手术，如传统腹腔镜手术、剖腹手术或传统多孔机器人手术。研究结果表明，通过 RGPT 进行的 RSS 手术是安全可行的，使用腕关节器械刚性仪器的平行设置可以很容易地在经阴道途径和经腹途径上进行。因此，这种手术可能是妇科医生在子宫肌瘤切除术、子宫腺肌瘤切除术、卵巢囊肿切除术和NOTES 子宫切除术等经阴道手术等重建或保留生育力手术领域的重要补充。然而，需要进一步的前瞻性对照研究来确定其在临床上的全面应用。
