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达芬奇Xi机器人系统在结直肠癌切除术中的应用——为何值得?

The use of the da Vinci Xi robot system in colorectal cancer resections - why is it worth it?

作者信息

Oko Michał, Kycler Witold, Janowski Jakub, Kozłowski Tomasz, Spychała Arkadiusz, Perz Hanna

机构信息

Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, Poznan, Poland.

Anaesthesiology and Intensive Care Department, Greater Poland Cancer Centre, Poznan, Poland.

出版信息

Pol Przegl Chir. 2021 Nov 2;94(2):12-18. doi: 10.5604/01.3001.0015.4552.

Abstract

<b>Introduction:</b> Surgery using robotic systems is taking over an increasingly wider field of open surgery and laparoscopy. Recently, this is particularly visible in colorectal surgery, where the advantages include better insight into the hard-to-reach area of the surgical field. Limited access to this method and relatively high costs remain a problem. </br></br> <b>Aim:</b> The aim of the work is to present the results of the introduction of robotic surgery at the regional Oncology Center in Wielkopolska in the field of safety and feasibility and the early oncological results for robotic colorectal surgery. </br></br> <b> Materials and methods:</b> From March 6, 2019 to the end of 2019, we performed 66 robotic colorectal procedures: 54 anterior resections of the sigmoid colon/rectum, 6 right hemicolectomies, 3 left hemicolectomies, 2 abdominoperineal resections, and one Hartmann's procedure. </br></br> <b> Results:</b> The final histopathological examination of all operated patients confirmed the complete resection (R0 procedure). The average age was 64 years and the average duration of surgery was 199 ± 52 min. None of the robotic procedures required conversion to open surgery or laparoscopy once they had started. The average hospitalization time was 6 ± 1 days, including patients with complications. Complications occurred in 8 patients, with the most common being anastomotic leak - 4 (6%). </br></br> <b>Conclusions:</b> The use of the latest da Vinci Xi robot system is a safe and effective alternative to open and laparoscopic surgery. Colorectal surgery confirms its special advantage in the case of low anterior resections of the rectum. Increasing the availability of equipment and training will allow expanding the scope of operations, including upper gastrointestinal tract.

摘要

引言:使用机器人系统进行的手术正在接管越来越广泛的开放手术和腹腔镜手术领域。最近,这在结直肠手术中尤为明显,其优势包括能更好地观察手术视野中难以触及的区域。然而,该方法的获取途径有限且成本相对较高,仍是一个问题。

目的:本研究旨在展示在大波兰地区肿瘤中心引入机器人手术在安全性、可行性方面的结果,以及机器人结直肠手术的早期肿瘤学结果。

材料与方法:从2019年3月6日至2019年底,我们共进行了66例机器人结直肠手术:54例乙状结肠/直肠前切除术、6例右半结肠切除术、3例左半结肠切除术、2例腹会阴联合切除术和1例哈特曼手术。

结果:所有接受手术患者的最终组织病理学检查均证实为完全切除(R0手术)。患者平均年龄为64岁,平均手术时长为199±52分钟。所有机器人手术一旦开始,均无需转为开放手术或腹腔镜手术。平均住院时间为6±1天,包括有并发症的患者。8例患者出现并发症,最常见的是吻合口漏——4例(6%)。

结论:使用最新的达芬奇Xi机器人系统是开放手术和腹腔镜手术安全有效的替代方案。结直肠手术在直肠低位前切除术方面证实了其特殊优势。增加设备的可及性和培训将有助于扩大手术范围,包括上消化道手术。

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