Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy.
Minimally Invasive and Robotic Gynecologic Surgery Unit, University of Modena and Reggio Emilia, Modena, Italy.
Updates Surg. 2021 Jun;73(3):1177-1187. doi: 10.1007/s13304-020-00939-8. Epub 2021 Feb 11.
The robotic platform is becoming a multidisciplinary tool, versatile, and suitable for multiple procedures. Combined multivisceral resections may represent an alternative to sequential procedures with a potential favorable impact on postoperative morbidity, and on the timing of administration of adjuvant chemotherapy. We herein present our initial experience with full robotic multivisceral resections, and a review of the literature available. Between January 2018 and April 2020, 11 patients underwent multivisceral full robotic abdominal surgery: 4 patients presented with two synchronous tumors, 4 with primary cancer associated with a benign condition and 3 cases involved deep infiltrating endometriosis. Surgical teams enrolled were: General Surgery, Urology and Gynecology. A systematic bibliographic research up to April 2020 was conducted in PubMed. 4 colorectal resections combined with partial or radical nephrectomy were performed, as well as 2 right colectomies in combination with right adrenalectomy and gastric banding removal, 2 radical prostatectomies with Nissen Fundoplication and abdominal wall hernia repair, and 3 resections of deep pelvic endometriosis with colorectal involvement. Mean total operative time was 367 min. No intraoperative complication or conversion to open was registered. Overall postoperative complication rate was 18.2%. 26 papers were included in the review (10 case series and 16 case reports) with a total of 156 combined multivisceral robotic procedures recorded. Robotic combined multivisceral resections proved to be safe and feasible when performed in high volume centers by expert surgeons. The heterogeneity of reports does not allow for a standardization of the procedure. Further studies and accumulation of experience are needed.
机器人平台正成为一种多学科工具，具有多功能性，适合多种手术。联合多脏器切除术可能是序贯手术的替代方案，有降低术后发病率和辅助化疗实施时间的潜在优势。我们在此介绍我们在全机器人多脏器切除方面的初步经验，并对现有文献进行了回顾。在 2018 年 1 月至 2020 年 4 月期间，11 名患者接受了全机器人多脏器腹部手术：4 名患者同时存在两个肿瘤，4 名患者存在原发性癌症合并良性疾病，3 例为深部浸润性子宫内膜异位症。涉及的手术团队包括普外科、泌尿科和妇科。在 PubMed 上进行了截至 2020 年 4 月的系统文献检索。进行了 4 例结直肠切除术联合部分或根治性肾切除术，2 例右半结肠切除术联合右肾上腺切除术和胃束带切除术，2 例根治性前列腺切除术联合 Nissen 胃底折叠术和腹壁疝修补术，以及 3 例涉及结直肠的深部盆腔子宫内膜异位症切除术。平均总手术时间为 367 分钟。无术中并发症或转为开放手术。总的术后并发症发生率为 18.2%。共纳入 26 篇文献（10 篇病例系列和 16 篇病例报告），共记录了 156 例联合多脏器机器人手术。在高容量中心由经验丰富的外科医生进行操作时，机器人联合多脏器切除术是安全可行的。报告的异质性使得该手术无法标准化。需要进一步的研究和经验积累。
