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机器人疝修补术 II. 英文版本:机器人原发性腹侧和切口疝修补术(rv-TAPP 和 r-Rives 或 r-TARUP)。视频报告和 118 例患者系列结果。

Robotic hernia repair II. English version : Robotic primary ventral and incisional hernia repair (rv‑TAPP and r‑Rives or r‑TARUP). Video report and results of a series of 118 patients.

机构信息

Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland.

Department of General, Visceral and Vascular Surgery, Cantonal Hospital Baden, Im Engel 1, 5404, Baden, Switzerland.

出版信息

Chirurg. 2021 Dec;92(Suppl 1):15-26. doi: 10.1007/s00104-021-01479-6. Epub 2021 Aug 10.

Abstract

Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.

摘要

在过去的 30 年中,内窥镜技术已经适应了传统腹腔镜器械的局限性,用于治疗脐疝和切口疝。这包括开发用于腹腔内放置(腹腔内补片修补术,IPOM)的防粘连涂层的补片;然而,这些患者中有相当一部分仍会发生粘连。微创手术的围手术期并发症较少,但复发率略高。由于机器人技术具有角度器械的优势,现在可以在不同的腹壁层以微创的方式植入补片,同时实现腹壁的形态和功能重建。本文视频介绍了使用机器人技术将补片植入腹膜前间隙(机器人辅助经腹腹膜前疝修补术,r-ventral TAPP)和后腹膜间隙(r-Rives 和机器人经腹肌后入路脐疝修补术,r-TARUP)治疗腹疝和切口疝。本文介绍了一项对 118 例连续患者的队列研究结果,并讨论了机器人技术在腹膜外补片植入和住院医师培训中的附加价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/512a/8695563/9b5e8b0b81d2/104_2021_1479_Fig1_HTML.jpg

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