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单孔全机器人辅助胸外科手术——技术要点、技巧与窍门

Uniportal pure robotic-assisted thoracic surgery-technical aspects, tips and tricks.

作者信息

Gonzalez-Rivas Diego, Manolache Veronica, Bosinceanu Mugurel Liviu, Gallego-Poveda Javier, Garcia-Perez Alejandro, de la Torre Mercedes, Turna Akif, Motas Natalia

机构信息

Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain.

Department of Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania.

出版信息

Ann Transl Med. 2023 Aug 30;11(10):362. doi: 10.21037/atm-22-1866. Epub 2022 Jun 24.

DOI:10.21037/atm-22-1866
PMID:37675313
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10477623/
Abstract

The uniportal access for robotic thoracic surgery presents itself as a natural evolution of minimally invasive thoracic surgery (MITS). It was developed by surgeons who pioneered the uniportal video-assisted thoracic surgery (U-VATS) in all its aspects following the same principles of a single incision by using robotic technology. The robotic surgery was initially started as a hybrid procedure with the use of thoracoscopic staplers by the assistant. However, due to the evolution of robotic modern platforms, the staplers can be nowadays controlled by the main surgeon from the console. The pure uniportal robotic-assisted thoracic surgery (U-RATS) is defined as the robotic thoracic surgery performed through a single intercostal (ic) incision, without rib spreading, using the robotic camera, robotic dissecting instruments and robotic staplers. There are presented the advantages, difficulties, the general aspects and specific considerations for U-RATS. For safety reasons, the authors recommend the transition from multiportal-RATS through biportal-RATS to U-RATS. The use of robotic dissection and staplers through a single incision and the rapid undocking with easy emergent conversion when needed (either to U-VATS or to thoracotomy) are safety advantages over multi-port RATS that cannot be overlooked, offering great comfort to the surgeon and quick and smooth recovery to the patient.

摘要

机器人辅助胸腔镜手术的单孔入路是微创胸外科手术（MITS）的自然演进。它由率先开展单孔电视辅助胸腔镜手术（U-VATS）各方面操作的外科医生开发，遵循单一切口的相同原则并采用机器人技术。机器人手术最初是一种混合手术，助手使用胸腔镜吻合器。然而，由于机器人现代平台的发展，如今吻合器可由主刀医生在控制台进行操作。纯单孔机器人辅助胸腔镜手术（U-RATS）被定义为通过单个肋间（ic）切口进行的机器人胸腔镜手术，不撑开肋骨，使用机器人摄像头、机器人解剖器械和机器人吻合器。文中介绍了U-RATS的优势、难点、一般情况和特殊注意事项。出于安全考虑，作者建议从多端口机器人辅助胸腔镜手术（RATS）经双端口RATS过渡到U-RATS。通过单一切口使用机器人进行解剖和吻合，以及在需要时（无论是转换为U-VATS还是开胸手术）快速拆卸并轻松紧急转换，这些都是多端口RATS无法忽视的安全优势，能为外科医生提供极大便利，使患者快速顺利康复。

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J Thorac Dis. 2019 Jan;11(1):231-239. doi: 10.21037/jtd.2018.12.94.
9
Long-term oncologic results for robotic major lung resection in non-small cell lung cancer (NSCLC) patients.非小细胞肺癌（NSCLC）患者机器人辅助肺叶切除术的长期肿瘤学结果。
Surg Oncol. 2019 Mar;28:223-227. doi: 10.1016/j.suronc.2019.02.003. Epub 2019 Feb 6.
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From "open" to robotic assisted thoracic surgery: why RATS and not VATS?从“开放”到机器人辅助胸外科手术：为什么是机器人辅助胸外科手术而不是电视辅助胸腔镜手术？
J Vis Surg. 2018 May 22;4:107. doi: 10.21037/jovs.2018.05.07. eCollection 2018.