Hepatobiliary and Retroperitoneal Sarcoma Division, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Ann Surg Oncol. 2024 Nov;31(12):7896-7897. doi: 10.1245/s10434-024-15952-z. Epub 2024 Aug 14.
Open radical cholecystectomy is the current "gold standard" for the management of gallbladder cancer. In well-selected patients, robotic radical cholecystectomy (RRC) can be a suitable alternative offering immediate postoperative benefits, such as less blood loss, shorter hospital stay, and fewer complications, while being oncologically equivalent. However, it requires a longer learning curve. METHODS: This video demonstrates the technical equivalence of the robotic approach when performing portal lymphadenectomy (station 8, 12, and 13) with emphasis on retraction techniques to emulate the open approach. In the case presented, a 40-year-old female patient had an intraluminal gallbladder mass with periportal nodes as revealed by computed tomography. Patient underwent a RRC with portal lymphadenectomy, performed on the DaVinci Xi robotic system. The surgery can be divided into five major steps: (1) Station 16b1 node sampling in the inter-aortocaval region; (2) Right portal lymphadenectomy (station 13, 12b, 12p); (3) Left portal lymphadenectomy (station 8a, 8p, 12a, 12p); (4) Anterior portal lymphadenectomy (station 12a, 12b); and (5) Cholecystectomy with liver wedge resection. The technical nuances of each of these steps is compared with its counterpart in the open approach to demonstrate equivalence. The key element in achieving a thorough oncological clearance is to replicate the retraction techniques of the open approach on the robotic platform by using vessel tapes for portal lymphadenectomy.
There remains little doubt regarding the feasibility and early postoperative benefits of RRC. This video demonstrates the equivalence of a standardized technique of robotic portal lymphadenectomy and liver wedge resection to the open approach. However, prospective studies are needed to further evaluate the long-term benefits of the procedure.
开腹根治性胆囊切除术是目前治疗胆囊癌的“金标准”。在选择合适的患者中，机器人根治性胆囊切除术（RRC）是一种可行的替代方法，可提供术后即刻获益，如出血量减少、住院时间缩短和并发症减少，同时在肿瘤学上也等效。然而，它需要更长的学习曲线。
本视频演示了在执行门脉淋巴结清扫术（站 8、12 和 13）时，机器人方法的技术等效性，重点强调了模仿开放方法的牵引技术。在本例中，一名 40 岁女性患者的胆囊腔内有肿块，伴有门静脉周围淋巴结，这是通过计算机断层扫描发现的。患者接受了 RRC 联合门脉淋巴结清扫术，在达芬奇 Xi 机器人系统上进行。手术可分为五个主要步骤：（1）腹主动脉旁区域的站 16b1 淋巴结取样；（2）右门脉淋巴结清扫（站 13、12b、12p）；（3）左门脉淋巴结清扫（站 8a、8p、12a、12p）；（4）前门脉淋巴结清扫（站 12a、12b）；（5）胆囊切除术和肝楔形切除术。这些步骤中的每一步的技术细节都与开放方法进行了比较，以证明其等效性。实现彻底肿瘤清除的关键要素是通过使用血管带在机器人平台上复制开放方法的牵引技术，用于门脉淋巴结清扫。
RRC 的可行性和术后早期获益已经得到证实。本视频演示了标准化的机器人门脉淋巴结清扫和肝楔形切除术技术与开放方法的等效性。然而，需要前瞻性研究来进一步评估该手术的长期获益。
