Wang X S
Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2021 Jan 25;24(1):35-42. doi: 10.3760/cma.j.cn.441530-20201213-00659.
In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.
在过去30年里,随着能量平台、器械平台和成像平台的发展,微创手术有了很大改进。以结直肠癌手术为例,手术操作的五个要素已在一定程度上得到发展。手术入路经历了从大到小的过程。切除范围从单纯肠切除发展到根治性切除/扩大根治性切除,再到侧重于保留器官功能的手术。随着对正常淋巴引流方向和肿瘤淋巴转移特征的认识,淋巴结清扫已逐渐标准化。消化道重建已从手工缝合转变为全内镜吻合,进而发展到功能性吻合的概念。标本切除已从经腹壁大切口改进为小腹腔镜切口,再到自然腔道。这些手术操作的演变取决于技术平台和设备的进步以及新观念的认识。微创平台的发展必须朝着确保实施最优化手术入路的方向前进。该平台应更安全、集成、多功能且智能化。未来,微创手术必须以最大化患者受益为目标。手术操作应更科学、功能性更强、更舒适且更多样化。手术创新推动了平台的发展。平台与手术操作相互促进发展。