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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (04): 212 -215. doi: 10.3877/cma.j.issn.1674-6899.2018.04.006

所属专题： 经典病例； 机器人手术； 文献资源库；

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机器人单孔腹腔镜妇科手术11例临床观察
顾成磊 1, 范文生 1, 杨雯 1, 王敏 1, 张妮娜 1, 李震 1, 孟元光 1 , †( )   
  1. 1. 100853 北京，解放军总医院妇产科
  • 收稿日期:2018-06-07 出版日期:2018-08-30
  • 通信作者: 孟元光

Robotic-assisted laparoendoscopic single-site gynecologic surgery: a report of 11 cases

Chenglei Gu 1, Wensheng Fan 1, Wen Yang 1, Min Wang 1, Nina Zhang 1, Zhen Li 1, Yuanguang Meng 1 , †( )   

  1. 1. Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2018-06-07 Published:2018-08-30
  • Corresponding author: Yuanguang Meng
  • About author:
    Corresponding author: Meng Yuanguang, Email:
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目的

探讨达芬奇机器人单孔腹腔镜手术系统施行妇科手术的安全性及可行性。

方法

回顾性分析解放军总医院妇产科2017年12月至2018年1月为11例患者施行达芬奇机器人单孔腹腔镜手术系统辅助妇科手术的临床资料。

结果

达芬奇机器人单孔腹腔镜手术系统共施行11例妇科手术，均获得成功。包括卵巢囊肿剥除术4例，全子宫＋双附件切除术3例，子宫肌瘤剔除＋卵巢囊肿剥除术1例，盆腔粘连松解＋卵巢囊肿剥除术1例，单侧附件切除术1例，输卵管系膜囊肿剥除术1例。手术操作时间(49.0±19.3)min，术中出血量(33.6 ± 24.2)ml，术后排气时间(17.3±3.1)h，术后住院时间(2.3±0.9)d。11例患者在术中、术后均无并发症发生，均痊愈出院。术后随访患者脐部切口隐蔽，瘢痕不易发觉。

结论

达芬奇机器人单孔腹腔镜手术系统应用于妇科领域是安全、可行的，但要求术者要熟悉盆腔解剖结构，而且应具备娴熟的腹腔镜技术。

关键词: 机器人手术, 单孔, 妇科手术, 微创外科, 腹腔镜
Objective

To investigate the safety and feasibility of the da Vinci robot-assisted laparoendoscopic single-site gynecologic surgery.

Methods

The clinical data were reviewed retrospectively in 11 patients undergoing da Vinci robot-assisted laparoendoscopic single-site gynecologic surgery from Dec. 2017 to Jan.2018 in Chinese PLA General Hospital.

Results

Robot-assisted laparoendoscopic single-site surgeries were successfully finished in all 11 cases.These gynecologic procedures including four ovarian cystectomies, three hysterectomies and bilateral salpingo-oophorectomies, one myomectomy and ovarian cystectomy, one pelvic adhesiolysis and ovarian cystectomy, one single salpingo-oophorectomubtotal hysterectomy, one mesosalpinx cystectomy. The console time was (49.0±19.3)min. The intra-operative blood loss was (33.6 ± 24.2)ml. The time of postoperative bowel recovery was (17.3±3.1)h and the postoperative hospital stay time was(2.3± 0.9)d.There were no intraoperative or postoperative complications in all cases.Single-site procedures were associated with good esthetic results because of minor abdominal trauma.

Conclusions

Robot-assisted laparoendoscopic single-site gynecologic surgeries are safe and feasible.The surgeons should master the anatomy of the pelvic cavity and master the laparoscopic technique skillfully.

Key words: Robotic surgery, Single-site, Gynecologic surgical procedure, Minimally invasive surgery, Laparoscope
表1 11例达芬奇机器人单孔腹腔镜妇科手术病例资料比较
病例序号 诊断 年龄(岁) 体质量指数(kg/m2) 手术方式
1 右卵巢畸胎瘤 25 18.4 机器人辅助单孔腹腔镜卵巢囊肿剥除术
2 右卵巢卵泡膜-纤维性肿瘤 62 19.6 机器人辅助单孔腹腔镜全子宫切除术＋双侧附件切除术
3 左侧卵巢子宫内膜异位囊肿 25 23.6 机器人辅助单孔盆腔粘连松解＋腹腔镜卵巢囊肿剥除术
4 子宫肌瘤、左侧卵巢子宫内膜异位囊肿 30 17.3 机器人辅助腹腔镜盆腔粘连松解术＋子宫肌瘤剔除术＋左侧卵巢囊肿剥除术
5 左侧卵巢浆液性囊腺瘤 45 22.5 机器人辅助单孔腹腔镜左侧卵巢囊肿剥除术
6 宫颈腺上皮非典型增生，多发子宫肌瘤 54 21.0 机器人辅助单孔腹腔镜全子宫切除术＋双侧附件切除术
7 双侧卵巢子宫内膜异位囊肿 35 18.0 机器人辅助单孔腹腔镜双侧卵巢囊肿剥除术
8 宫颈高级别鳞状上皮内病变 43 22.1 机器人辅助单孔腹腔镜全子宫＋双侧附件切除术
9 子宫内膜异位囊肿 30 20.6 机器人辅助单孔腹腔镜卵巢囊肿剥除术
10 子宫腺肌症、右侧输卵管系膜囊肿 33 16.7 机器人辅助单孔腹腔镜右侧输卵管系膜囊肿剥除术＋节育器置入术
11 左卵巢畸胎瘤 48 25.6 机器人辅助单孔腹腔镜单侧附件切除术
图1 da Vinci Single-Site专用器械
图2 置入复合Trocar、镜头、机械臂及辅助器械
图3 达芬奇机器人单孔腹腔镜手术操作
图4 术后1 d切口恢复情况
1
Stein RJ, White WM, Goel RK, et al. Robotic laparoendoscopic single-site surgery using gelport as the access platform[J]. European Urology, 2010, 57(1):132-136.
2
Irwin BH, Rao PP, Stein RJ, et al. Laparoendoscopic single site surgery in urology[J]. Urol Clin North Am, 2009，36(2):223-235.
3
刘海元，孙大为，张俊吉，等. 《妇科单孔腔镜手术技术专家共识》解读[J/CD]. 中华腔镜外科杂志(电子版), 2017, 10(1):1-6.
4
马迎春，Guan Xiaoming. 机器人单孔腹腔镜手术在妇科领域中的应用[J/CD]. 妇产与遗传(电子版), 2015, 5(3):44-47.
5
Gomes M, Machado A, Podgaec S, et al. Initial experience with single-port robotic hysterectomy[J]. Einstein, 2017, 15(4):476-480.
6
Lee GS, Arghami A, Dy BM, et al. Robotic single-site adrenalectomy[J]. Surgical Endoscopy, 2016, 30(8):3351-3356.
7
Corcione F, Bracale U, Pirozzi F, et al. Robotic single-access splenectomy using the Da Vinci Single-Site ®platform: a case report[J]. International Journal of Medical Robotics & Computer Assisted Surgery, 2014, 10(1):103-106.
8
Maurice MJ, Ramirez D, Kaouk JH. Robotic laparoendoscopic single-site retroperitioneal renal surgery: initial investigation of a purpose-built single-port surgical system[J]. European Urology, 2016, 71(4):643-647.
9
Hagen ME, Balaphas A, Podetta M, et al. Robotic single-site versus multiport laparoscopic cholecystectomy: a case-matched analysis of short- and long-term costs[J]. Surgical Endoscopy & Other Interventional Techniques, 2017, 32(2):1-6.
10
Tarasconi JC. Endoscopic salpingectomy[J]. Journal of Reproductive Medicine, 1981, 26(10):541-545.
11
Pelosi MA, Rd PM. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy)[J]. Journal of Reproductive Medicine, 1992, 37(7):588-594.
12
Barret E, Sanchezsalas R, Cathelineau X, et al. Re: initial complete laparoendoscopic single-site surgery robotic assisted radical prostatectomy(LESS-RARP)[J]. International Braz J Urol Official Journal of the Brazilian Society of Urology, 2009, 35(1):92-93.
13
Escobar PF, Fader AN, Paraiso MF, et al. Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique[J]. Journal of Minimally Invasive Gynecology, 2009, 16(5):589-591.
14
Vizza E, Corrado G, Mancini E, et al. robotic single－site hysterectomy in low risk early endometrial cancer: a pilot study[J]. Annals of Surgical Oncology, 2013, 20(8):2759-2764.
15
Fanfani F, Monterossi G, Fagotti A, et al. Laparoendoscopic single-site hysterectomy: is it safe and feasible[J]. Current Opinion in Obstetrics & Gynecology, 2014, 26(4):275-280.
16
Moukarzel LA, Fader AN, Tanner EJ. Feasibility of robotic assisted laparoendoscopic single-site surgery in the gynecologic oncology setting[J]. J Minim Invasive Gynecol, 2016, 22(6):49-55.
17
Emad K, Noureldine SI, Bob S, et al. Robotic liver resection: initial experience with three-arm robotic and single-port robotic technique[J]. Jsls Journal of the Society of Laparoendoscopic Surgeons, 2013, 17(1):56-62.
18
Morelli L, Guadagni S, Franco GD, et al. Da Vinci single site surgical platform in clinical practice: a systematic review[J]. International Journal of Medical Robotics & Computer Assisted Surgery, 2015, 12(4):724-734.
19
Paek J, Lee JD, Kong TW, et al. Robotic single-site versus laparoendoscopic single-site hysterectomy: a propensity score matching study[J]. Surgical Endoscopy & Other Interventional Techniques, 2016, 30(3):1043-1050.
20
Moukarzel LA, Sinno AK, Fader AN, et al. Comparing single-site and multiport robotic hysterectomy with sentinel lymph node mapping for endometrial cancer: surgical outcomes and cost analysis[J]. Journal of Minimally Invasive Gynecology, 2017，24(6):977-983.
21
El HL, Andikyan V, Mathews S, et al. Robotic single-site and conventional laparoscopic surgery in gynecology: clinical outcomes and cost analysis of a matched case-control study[J]. Journal of Minimally Invasive Gynecology, 2016, 23(5):760-768.
22
Joliniere JBD, Librino A, Dubuisson JB, et al. Robotic surgery in gynecology[J]. Frontiers in Surgery, 2016, 3(2):26-26.
23
Morelli L, Di FG, Guadagni S, et al. Full robotic colorectal resections for cancer combined with other major surgical procedures[J]. Surgical Innovation, 2017, 24(4):321-327.
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