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达芬奇单孔(SP)机器人手术在结直肠患者中的早期单中心经验

Early Single-Center Experience of DaVinci Single-Port (SP) Robotic Surgery in Colorectal Patients.

作者信息

Cho Hye Jung, Kim Woo Ram

机构信息

Division of Colorectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.

出版信息

J Clin Med. 2024 May 19;13(10):2989. doi: 10.3390/jcm13102989.

Abstract

DaVinci single-port (SP) robotic surgery offers several benefits compared to traditional multiport laparoscopic or robotic surgeries. One of the main advantages is that it allows for a minimally invasive approach, resulting in a single, smaller incision and reduced trauma to the patient's body, leading to less postoperative pain, faster recovery, and reduced risk of complications. The cosmesis of a single port with minimal visible scarring is also an attractive aspect to the patients; however, many surgeons use an additional port for energy device, stapler use, and drain insertion. Pure single-port surgery with one incision is still rare. Here, we share our experience of our first 10 cases using the SP robotic platform in colorectal surgery. From May 2023 to December 2023, colorectal patients who underwent SP robotic surgery were analyzed. Placement of the incision was the umbilicus for eight patients, and right lower quadrant for two patients, through which ileostomy maturation was performed. Data on perioperative parameters and postoperative outcomes were analyzed, with a median follow-up of 4.6 months (range 0.6-7.4 months). A total of 10 colorectal patients underwent DaVinci single-port robotic colorectal surgery at our institution during this period. The patient demographic was four males (40%) and six females (60%) with a median age of 63.5 years (range 50-75 years). Median body mass index (BMI) was 22.89 kg/m (range 19.92-26.84 kg/m). Nine patients were diagnosed with colorectal cancer, and one patient was diagnosed with a rectal gastrointestinal tumor. One patient underwent anterior resection and cholecystectomy simultaneously. Mean operation time was 222 min (range 142-316 min), and mean wound size was 3.25 cm (range 2.5-4.5 cm). Nine patients underwent surgery with single incision through which a single-port trocar was inserted, and one patient had one additional port for drain insertion. Mean hospital stay was 6 days (range 4-8 days) with one postoperative complication of bleeding requiring transfusion, but there was no readmission within 30 days. Overall, our experience with single-port robotic colorectal surgery has been promising. With only one patient with additional port for drain insertion, all nine patients underwent SP-robotic surgery with single incision for colon as well as rectal surgeries. Compared to an average postoperative length of stay of 6.5-8 days in laparoscopic colorectal surgeries reported in literature, SP-robotic surgery 33showed faster recovery of 6 days highlighting its benefits in patient recovery and satisfaction.

摘要

与传统的多端口腹腔镜手术或机器人手术相比,达芬奇单端口(SP)机器人手术具有诸多优势。其主要优点之一是它允许采用微创方法,只需一个较小的切口,对患者身体的创伤较小,从而减少术后疼痛、加快恢复速度并降低并发症风险。单个端口留下的可见疤痕极小,其美容效果对患者也很有吸引力;然而,许多外科医生会额外使用一个端口来连接能量设备、使用吻合器和插入引流管。真正的单切口单端口手术仍然很少见。在此,我们分享我们在结直肠手术中使用SP机器人平台进行的前10例手术的经验。2023年5月至2023年12月,对接受SP机器人手术的结直肠患者进行了分析。8例患者的切口位于脐部,2例患者的切口位于右下腹,通过这些切口进行了回肠造口成熟术。分析了围手术期参数和术后结果,中位随访时间为4.6个月(范围0.6 - 7.4个月)。在此期间,我们机构共有10例结直肠患者接受了达芬奇单端口机器人结直肠手术。患者人口统计学数据为4名男性(40%)和6名女性(60%),中位年龄为63.5岁(范围50 - 75岁)。中位体重指数(BMI)为22.89 kg/m(范围19.92 - 26.84 kg/m)。9例患者被诊断为结直肠癌,1例患者被诊断为直肠胃肠道肿瘤。1例患者同时接受了前切除术和胆囊切除术。平均手术时间为222分钟(范围142 - 316分钟),平均伤口大小为3.25厘米(范围2.5 - 4.5厘米)。9例患者通过单个切口进行手术,通过该切口插入了单端口套管针,1例患者额外有一个端口用于插入引流管。平均住院时间为6天(范围4 - 8天),有1例术后出血并发症需要输血,但30天内无再次入院情况。总体而言,我们在单端口机器人结直肠手术方面的经验很有前景。只有1例患者有额外的端口用于插入引流管,其余9例患者均通过单个切口进行了SP机器人结肠和直肠手术。与文献报道的腹腔镜结直肠手术平均术后住院时间6.5 - 8天相比,SP机器人手术的恢复速度更快,为6天,凸显了其在患者恢复和满意度方面的优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/234a/11121993/affb116e15e4/jcm-13-02989-g001.jpg

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