Matteucci Matteo, Bruzzone Paolo, Pinto Sabrina, Covarelli Piero, Boselli Carlo, Popivanov Georgi I, Cirocchi Roberto
Department of General Surgery, University of Milan, 20122 Milan, Italy.
Department of General and Specialist Surgery, University of Roma La Sapienza, 00185 Rome, Italy.
J Clin Med. 2024 Dec 1;13(23):7305. doi: 10.3390/jcm13237305.
Inguinal-iliac-obturator lymph node dissection is essential in the treatment of patients with cutaneous melanoma exhibiting the clinical or radiological involvement of pelvic lymph nodes. The open procedure is associated with elevated mortality rates. Numerous minimally invasive approaches have been suggested to mitigate the impact of this surgery on the patient's quality of life. The preliminary findings of robotic-assisted dissection have been documented in the literature. They demonstrate a decrease in potential issues linked to robotic-assisted treatments as compared to open or video laparoscopic methods. No implications have been reported for long-term oncological outcomes. The present study compares the outcomes in 64 patients with robotic procedures, 187 with videoscopic procedures, and 83 with open pelvic lymph node dissection (PLND). However, the quality of evidence is too low to draw any valid conclusions. The available literature shows that a robotic procedure is feasible and has similar complication rates and oncological outcomes to other methods. The reason for the shorter operative time is not clear, but is associated with lower hospital costs. It is probable that, from a surgeon's point of view, robotic techniques offer several advantages over videoendoscopic techniques, such as three-dimensional imaging, ergonomic control, and tools that mimic human hand movements. Randomized controlled trials are necessary to validate the benefits of robotic inguinal-iliac-obturator lymph node dissection (RIIOL) compared to videoscopic and open procedures, but the recruitment rate is very low because of the restricted indications for lymph node dissection against the background of the continuously evolving system of therapy.
腹股沟-髂-闭孔淋巴结清扫术对于治疗临床或影像学显示盆腔淋巴结受累的皮肤黑色素瘤患者至关重要。开放手术的死亡率较高。人们提出了多种微创方法来减轻该手术对患者生活质量的影响。文献中已记录了机器人辅助清扫术的初步研究结果。与开放手术或视频腹腔镜手术相比，这些结果表明机器人辅助治疗相关的潜在问题有所减少。目前尚无关于长期肿瘤学结局的报道。本研究比较了64例行机器人手术、187例行视频腹腔镜手术和83例行开放盆腔淋巴结清扫术（PLND）患者的结局。然而，证据质量过低，无法得出任何有效结论。现有文献表明，机器人手术是可行的，其并发症发生率和肿瘤学结局与其他方法相似。手术时间较短的原因尚不清楚，但与较低的住院费用相关。从外科医生的角度来看，机器人技术可能比视频内镜技术具有多种优势，例如三维成像、符合人体工程学的控制以及模仿人类手部动作的工具。与视频腹腔镜手术和开放手术相比，有必要进行随机对照试验以验证机器人腹股沟-髂-闭孔淋巴结清扫术（RIIOL）的益处，但由于在不断发展的治疗体系背景下淋巴结清扫术的适应证有限，招募率非常低。
