Papp András, Palkovics András, Sindler Dóra Lili, Papp Csenge, Halvax Péter, Czimmer József, Nagy Bálint, Vereczkei András
1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Sebészeti Klinika Pécs, Ifjúság útja 13., 7624 Magyarország.
2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, I. Belgyógyászati Klinika Pécs Magyarország.
Orv Hetil. 2023 Apr 9;164(14):542-547. doi: 10.1556/650.2023.32748.
The outcomes of surgical interventions for achalasia treatment improved with the advent of minimally invasive surgery. Robotic-assisted Heller-Dor's (RAHD) procedure established over the last years, provides important advantages to surgeons, such as binocular three-dimensional vision and improvement of fine motor control.
Between October and December of 2022, first in Hungary, 3 patients (37-year-old man, 55- and 72-year-old women) underwent RAHD procedure for achalasia at the Clinical Centre of the University of Pécs using the da Vinci Xi system.
RAHD procedure was feasible without any particular problems and the postoperative course of all three patients was uneventful. The operation times were 198, 204 and 238 minutes, including 23, 19 and 14 minutes for the setup time of the robot. By the last patient, due to an accompanying hiatal hernia, an additional hiatal reconstruction was also performed. In the first 2 cases, the patients were discharged on the 4th postoperative day, while in the last case, with the additional hiatal reconstruction, the patient was emitted on the 6th postoperative day.
There are several published studies about RAHD cardiomyotomy. The general conclusion is that, in experienced hands, RAHD procedure is easy to perform, ensures a meticulous esophageal and gastric myotomy, allowing to visualize and divide each muscle fiber with a significantly lower rate of mucosal perforations. However, by RAHD procedure, the overall costs are higher, including a longer operation time during the learning curve. At the same time, the avoidance of mucosal lacerations and their possible consequences has to be weighed against the higher overall costs.
Laparoscopic cardiomyotomy is the first standard upper-gastrointestinal operation where a clear advantage of the use of a surgical robot has been proven. Thus, wherever this equipment is available, it should be preferred for this procedure. Orv Hetil. 2023; 164(14): 542-547.
随着微创手术的出现，贲门失弛缓症手术治疗的效果得到了改善。过去几年建立的机器人辅助赫勒-多尔（RAHD）手术为外科医生提供了重要优势，如双目三维视觉和精细运动控制的改善。
2022年10月至12月期间，在匈牙利首次有3例患者（1名37岁男性、2名分别为55岁和72岁的女性）于佩奇大学临床中心使用达芬奇Xi系统接受了RAHD手术治疗贲门失弛缓症。
RAHD手术可行，无任何特殊问题，所有3例患者术后病程平稳。手术时间分别为198分钟、204分钟和238分钟，其中机器人设置时间分别为23分钟、19分钟和14分钟。最后1例患者因伴有食管裂孔疝，还额外进行了裂孔重建。前2例患者术后第4天出院，而最后1例因额外进行了裂孔重建，术后第6天出院。
关于RAHD贲门肌切开术已有多项发表的研究。总体结论是，在经验丰富的医生手中，RAHD手术易于实施，能确保细致的食管和胃肌切开术，可清晰看到并分离每根肌纤维，黏膜穿孔率显著降低。然而，RAHD手术总体成本较高，包括在学习曲线阶段手术时间较长。同时，必须权衡避免黏膜撕裂及其可能后果与较高的总体成本。
腹腔镜贲门肌切开术是首个已证明使用手术机器人具有明显优势的标准上消化道手术。因此，只要有该设备，此手术应优先选用。《匈牙利医学周报》2023年；164(14):542 - 547。
