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新型机器人平台(CMR Versius)下的机器人结直肠肿瘤外科手术:希望还是炒作?一项全机器人病例系列的初步经验。

Robotic oncologic colorectal surgery with a new robotic platform (CMR Versius): hope or hype? A preliminary experience from a full-robotic case-series.

机构信息

Casa di Cura Cobellis, Vallo della Lucania, Salerno, Italy.

Department of Surgical Oncology, Robotics and New Technologies, Policlinico Abano, Padua, Italy.

出版信息

Tech Coloproctol. 2022 Sep;26(9):745-753. doi: 10.1007/s10151-022-02626-9. Epub 2022 May 30.

Abstract

BACKGROUND

The present case-series describes the first full-robotic colorectal resections performed with the new CMR Versius platform (Cambridge Medical Robotics Surgical, 1 Evolution Business Park, Cambridge, United Kingdom) by an experienced robotic surgeon.

METHODS

In a period between July 2020 and December 2020, patients aged 18 years or older, who were diagnosed with colorectal cancer and were fit for minimally invasive surgery, underwent robotic colorectal resection with CMR Versius robotic platform at "Casa di Cura Cobellis" in Vallo della Lucania,Salerno, Italy. Three right colectomies, 2 sigmoid colectomies and 1 anterior rectal resection were performed. All the procedures were planned as fully robotic. Surgical data were retrospectively reviewed from a prospectively collected database.

RESULTS

Four patients were male and 2 patients were female with a median (range) age of 66 (47-72) years. One covering ileostomy was created. Full robotic splenic flexure mobilization was performed. No additional laparoscopic gestures or procedures were performed in this series except for clipping and stapling which were performed by the assistant surgeon due to the absence of robotic dedicated instruments. Two ileocolic anastomoses, planned as robotic-sewn, were performed extracorporeally. One Clavien-Dindo II complication occurred due to a postoperative blood transfusion. Median total operative time was 160 (145-294) min for right colectomies, 246 (191-300) min for sigmoid colectomies and 250 min for the anterior rectal resection.

CONCLUSIONS

The present series confirms the feasibility of full-robotic colorectal resections while highlighting the strengths and the limitations of the CMR Versius platform in colorectal surgery. New devices will need more clinical development to be comparable to the current standard.

摘要

背景

本病例系列描述了一位经验丰富的机器人外科医生使用新的 CMR Versius 平台(英国剑桥的 Cambridge Medical Robotics Surgical,1 Evolution Business Park)进行的首例全机器人结直肠切除术。

方法

在 2020 年 7 月至 2020 年 12 月期间,年龄在 18 岁或以上、诊断为结直肠癌且适合微创手术的患者在意大利萨莱诺省瓦洛德拉卢卡纳的“Casa di Cura Cobellis”接受了 CMR Versius 机器人平台的机器人结直肠切除术。共进行了 3 例右半结肠切除术、2 例乙状结肠切除术和 1 例前直肠切除术。所有手术均计划为全机器人手术。从一个前瞻性收集的数据库中回顾性地审查了手术数据。

结果

4 例为男性,2 例为女性,中位(范围)年龄为 66(47-72)岁。其中 1 例患者进行了回肠造口术。进行了全机器人脾曲游离。除了助手外科医生因缺乏机器人专用器械而进行的夹闭和吻合钉合外,本系列中未进行任何其他腹腔镜操作。2 例计划行机器人缝合的回肠结肠吻合术均在体外进行。1 例因术后输血发生 Clavien-Dindo II 级并发症。右半结肠切除术的中位总手术时间为 160(145-294)min,乙状结肠切除术为 246(191-300)min,前直肠切除术为 250 min。

结论

本系列证实了全机器人结直肠切除术的可行性,同时突出了 CMR Versius 平台在结直肠手术中的优势和局限性。新设备需要更多的临床开发才能与当前标准相媲美。

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