Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Street, Changsha, Hunan, People's Republic of China.
Tianjin University, Tianjin, People's Republic of China.
Tech Coloproctol. 2022 Jan;26(1):19-28. doi: 10.1007/s10151-021-02546-0. Epub 2021 Nov 30.
BACKGROUND: The advantages and disadvantages of robotic technology compared with conventional surgery for low rectal cancer have been discussed extensively. However, a few studies on the efficacy of total mesorectal excision (TME) with different robotic technologies have been reported. The aim of this study was to evaluate the efficacy of two types of robot-assisted TME (R-TME) compared with laparoscopic TME (L-TME). METHODS: A prospective comparative study was conducted comparing da Vinci R-TME, Micro Hand S R-TME, and L-TME for rectal cancer. This study was registered with "Clinicaltrials.gov" (ID: NCT02752698) and approved by the Association for the Accreditation of Human Research Protection Program (AAHRPP) (Project number: T16007). Between January 2017 and May 2019, patients with rectal cancer (cT1-3NxM0) were prospectively registered in the Third Xiangya Hospital. The integrity of the TME sample served as the primary outcome. Secondary outcomes included the involvement of the circumferential and distal resection margins (CRM and DRM), number of lymph nodes retrieved, blood loss, operative time, conversion rate, comprehensive complication index score, the International Prostate Symptom score, the International Index of Erectile Function, and the Female Sexual Function Index. RESULTS: Of 134 patients with rectal cancer (74 males, mean age [SD] 59.1 ± 8.27 years), 46 patients underwent laparoscopic TME, 45 patients underwent da Vinci R-TME, and 43 patients underwent Micro Hand S R-TME. There were no differences in results between the two types of R-TME. Compared with laparoscopic TME, significant reductions in blood loss (median 65.50 ml da Vinci; median 66.54 ml Micro Hand S vs median 95.04 ml L-TME p = 0.037 and p = 0.041, respectively) and conversion rate (2.2% da Vinci; 2.3% Micro Hand S vs 6.8% L-TME p = 0,040 for the comparison daVinci L-TME and p = 0.038 for the comparison Micro Hand S vs. L-TME) with da Vinci Si and Micro Hand S R-TME were noted, and significant increases in operation time (230.05 min da Vinci; 235.03 min Micro Hand S vs. 205.53 min L-TME p = 0.045 and p = 0.043, respectively) was observed. Additionally, more patients underwent TME with sphincter-preserving methods in the two R-TME groups based on the type of operation (da Vinci 97.7%; Micro Hand S 97.9% vs. L-TME 82% resulting in p = 0.033 for the comparison daVinci L-TME and p = 0.035 for the comparison Micro Hand S vs. L-TME). In comparison with L-TME, there was a larger number of lymph nodes retrieved (da Vinci mean 17.54; Micro Hand S mean 17.32 vs. L-TME mean 14.96 p = 0.031 for the comparison daVinci L-TME and p = 0.033 for the comparison Micro Hand S vs L-TME) and less blood loss (da Vinci mean 65.50 ml; Micro Hand S mean 66.54 ml vs. L-TME mean 95.04 ml, p = 0.037 for the comparison daVinci L-TME and p = 0.041 for the comparison Micro Hand S vs. L-TME), and incidence of severe postoperative complications was similar among three TME groups except for the earlier recovery of urogenital function (mean IPSS score da Vinci 7.73±1.35; Micro Hand S7.75±1.47 vs L-TME 14.26±1.41 p<0.001 for the comparison da Vinci L-TME and p<0.001 for the comparison Microhand S vs L-TME) in the two R-TME groups. CONCLUSIONS: In our study, compared with laparoscopic surgery, da Vinci or Micro Hand R-TME exhibited similar superiority in the quality of oncologic resection, postoperative morbidity, and recovery of postoperative function.
背景：与传统手术相比，机器人技术在低位直肠癌中的优势和劣势已经被广泛讨论。然而，只有少数关于不同机器人技术全直肠系膜切除术（TME）疗效的研究报告。本研究旨在评估两种类型的机器人辅助 TME（R-TME）与腹腔镜 TME（L-TME）相比的疗效。
方法：前瞻性比较研究比较了达芬奇 R-TME、Micro Hand S R-TME 和 L-TME 治疗直肠癌。本研究在“Clinicaltrials.gov”（注册号：NCT02752698）注册，并获得了人类研究保护计划认证协会（AAHRPP）的批准（项目编号：T16007）。2017 年 1 月至 2019 年 5 月，在湘雅三医院前瞻性登记了直肠癌患者（cT1-3NxM0）。TME 标本的完整性是主要结局。次要结局包括环周和远端切缘（CRM 和 DRM）受累情况、淋巴结检出数量、出血量、手术时间、中转率、综合并发症指数评分、国际前列腺症状评分、国际勃起功能指数和女性性功能指数。
结果：134 例直肠癌患者（74 例男性，平均年龄[SD]59.1±8.27 岁）中，46 例行腹腔镜 TME，45 例行达芬奇 R-TME，43 例行 Micro Hand S R-TME。两种 R-TME 之间的结果无差异。与腹腔镜 TME 相比，达芬奇组出血量（中位数 65.50ml；中位数 66.54ml Micro Hand S 与中位数 95.04ml L-TME，p=0.037 和 p=0.041）和中转率（2.2%达芬奇；2.3%Micro Hand S 与 6.8%L-TME，p=0.040 用于达芬奇与 L-TME 的比较，p=0.038 用于 Micro Hand S 与 L-TME 的比较）显著降低，达芬奇和 Micro Hand S R-TME 手术时间（230.05min 达芬奇；235.03min Micro Hand S 与 205.53min L-TME，p=0.045 和 p=0.043）显著增加。此外，两种 R-TME 组基于手术类型行 TME 保肛术的患者比例更高（达芬奇 97.7%；Micro Hand S 97.9%与 L-TME 82%，导致达芬奇与 L-TME 比较 p=0.033，Micro Hand S 与 L-TME 比较 p=0.035）。与 L-TME 相比，达芬奇和 Micro Hand S R-TME 组的淋巴结检出数量更多（达芬奇平均 17.54 个；Micro Hand S 平均 17.32 个与 L-TME 平均 14.96 个，p=0.031 用于达芬奇与 L-TME 的比较，p=0.033 用于 Micro Hand S 与 L-TME 的比较），出血量更少（达芬奇平均 65.50ml；Micro Hand S 平均 66.54ml 与 L-TME 平均 95.04ml，达芬奇与 L-TME 比较 p=0.037，Micro Hand S 与 L-TME 比较 p=0.041），严重术后并发症的发生率相似，但达芬奇和 Micro Hand S R-TME 组的尿生殖功能恢复更早（平均 IPSS 评分达芬奇 7.73±1.35；Micro Hand S7.75±1.47 与 L-TME 14.26±1.41，p<0.001 用于达芬奇与 L-TME 的比较，p<0.001 用于 Microhand S 与 L-TME 的比较）。
结论：在本研究中，与腹腔镜手术相比，达芬奇或 Micro Hand R-TME 在肿瘤切除质量、术后发病率和术后功能恢复方面具有相似的优势。
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