Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Surg Endosc. 2023 May;37(5):4084-4087. doi: 10.1007/s00464-023-10016-x. Epub 2023 Mar 23.
Improving oncological curability and preserving urinary function must be established in robotic total mesorectal excision (TME) for rectal cancer. To achieve this, it is important to avoid nerve injury by sharp dissection of the avascular plane by the monopolar device and thermal spread. The aim of this study was to improve the robotic TME quality by focusing on the theory of fundamental use of surgical energy (FUSE) of the monopolar device and investigating the surgical procedure.
In this single-center retrospective study, 26 consecutive patients who underwent robotic TME for rectal cancer at Tokyo Medical University Hospital between June 2022 and August 2022 were included. All surgeries were performed by FUSE-certified surgeons in accordance with FUSE theory, which was, thermal effect = current density (current/area) squared × tissue resistance × contact time.
The median age of the patients was 64 years (range 40-79 years), and 17 patients were male. The median operative time was 287 min (range 229-430 min); median bleeding volume, 22 ml (range 5-223 ml); and the median number of harvested lymph nodes, 17 (range 4-40). The conversion rate to open surgery was 0%. A breakdown of Clavien-Dindo classification Grade ≥ II post-operative complications was as follows: surgical site infection, one patient (3.8%); ileus, one patient (3.8%); and urinary dysfunction, one patient (3.8%). No surgery-related or in-hospital deaths occurred. The pathological positive resection margin was not observed.
Robotic TME for rectal cancer based on the theory of FUSE can be safely performed, making it a promising surgical procedure. It is suggested that robotic surgeons acquire surgical operation skills with monopolar devices based on the principles of FUSE, which may lead to an increased quality of robotic TME.
提高肿瘤学治愈率和保护尿功能必须在机器人全直肠系膜切除术（TME）中建立，以治疗直肠癌。为了实现这一目标，通过使用单极器械进行无血管平面的锐性解剖和热扩散来避免神经损伤非常重要。本研究旨在通过关注单极器械的基本外科能量利用理论（FUSE）并研究手术过程来提高机器人 TME 的质量。
在这项单中心回顾性研究中，纳入了 2022 年 6 月至 2022 年 8 月期间在东京医科大学医院接受机器人 TME 治疗直肠癌的 26 例连续患者。所有手术均由 FUSE 认证的外科医生按照 FUSE 理论进行，该理论为热效应=电流密度（电流/面积）的平方×组织电阻×接触时间。
患者的中位年龄为 64 岁（范围 40-79 岁），男性 17 例。中位手术时间为 287 分钟（范围 229-430 分钟）；中位出血量为 22 毫升（范围 5-223 毫升）；中位采集的淋巴结数为 17 个（范围 4-40 个）。中转开腹率为 0%。Clavien-Dindo 分级≥Ⅱ级的术后并发症如下：手术部位感染 1 例（3.8%）；肠梗阻 1 例（3.8%）；和尿功能障碍 1 例（3.8%）。没有发生与手术相关或院内死亡。未观察到病理阳性切缘。
基于 FUSE 理论的机器人 TME 治疗直肠癌可以安全进行，是一种很有前途的手术方法。建议机器人外科医生在 FUSE 原则的基础上获得使用单极器械的手术操作技能，这可能会提高机器人 TME 的质量。
