使用完全胃吻合钉合线生物可吸收加固技术的全机器人袖状胃切除术:我的手术方法(视频)
Fully Robotic Sleeve Gastrectomy Using Complete Gastric Staple Line Bioabsorbable Reinforcement: How I Do It (a Video).
作者信息
Amor Imed Ben, Lainas Panagiotis, Alghareeb Fahad, Amor Sarah Ben, Rassouli Rayan, Baqué Patrick
机构信息
Department of Digestive Surgery, Archet II Hospital, Nice, France.
University of Nice-Sophia-Antipolis, Nice, France.
出版信息
Obes Surg. 2025 Jun;35(6):2384-2386. doi: 10.1007/s11695-025-07880-y. Epub 2025 Apr 23.
Robotic sleeve gastrectomy (RSG) is gaining place among surgeons. In our initial RSG practice, we noticed that gastric staple line intraoperative bleeding is more frequent and more important compared to the conventional laparoscopic approach. Any technique that could reduce the likelihood of intraoperative bleeding in RSG would be of tremendous benefit. The present video report is a detailed description of a fully RSG using complete gastric staple line bioabsorbable reinforcement, minimizing intraoperative bleeding. We present the case of a 32-year-old female patient with severe obesity (weight = 132 kg; BMI = 46.8 kg/m2) that underwent fully RSG in our department. RSG technique is thoroughly described, highlighting several important aspects of RSG, including (i) patient positioning to optimize access and ergonomics; (ii) the use of a Nathanson liver retractor, avoiding interference with robotic arms; (iii) trocar placement strategy; (iv) intraoperative selection of stapler reloads; and (v) the use of a bioabsorbable reinforcement (Seamguard®, Gore) for staple line reinforcement and bleeding minimization. Operative time was 180 min, and, blood loss was minimal (< 10 ml). The patient was discharged on postoperative day 1. Postoperative recovery was uneventful, without bleeding, gastric leak, or other complications. Only simple oral analgesics were required postoperatively. At 1-month follow-up visit, the patient had lost 10 kg and reported significant improvement in overall health. Complete gastric staple line bioabsorbable reinforcement seems to decrease intraoperative bleeding when the robotic approach is used for sleeve gastrectomy. Prospective randomized studies are needed to validate this approach as gold standard practice for RSG.
机器人袖状胃切除术(RSG)在外科医生中越来越受欢迎。在我们最初开展RSG的实践中,我们注意到与传统腹腔镜手术相比,胃吻合钉线术中出血更为频繁且出血量更大。任何能够降低RSG术中出血可能性的技术都将带来巨大益处。本视频报告详细描述了一种使用完全可生物吸收的胃吻合钉线加固材料的全RSG手术,将术中出血降至最低。我们展示了一名32岁重度肥胖女性患者(体重 = 132 kg;BMI = 46.8 kg/m²)在我们科室接受全RSG手术的病例。详细描述了RSG技术,突出了RSG的几个重要方面,包括:(i)患者体位以优化手术入路和操作舒适度;(ii)使用纳森森肝脏牵开器,避免干扰机器人手臂;(iii)套管针放置策略;(iv)术中吻合器重新装填的选择;以及(v)使用可生物吸收的加固材料(Seamguard®,戈尔公司)来加固吻合钉线并减少出血。手术时间为180分钟,出血量极少(< 10 ml)。患者术后第1天出院。术后恢复顺利,无出血、胃漏或其他并发症。术后仅需简单的口服镇痛药。在1个月的随访中,患者体重减轻了10 kg,报告整体健康状况有显著改善。当采用机器人手术进行袖状胃切除术时,完全可生物吸收的胃吻合钉线加固材料似乎能减少术中出血。需要进行前瞻性随机研究以验证这种方法作为RSG的金标准术式。