腹部无辅助切口经阴道取标本的全机器人远端胃切除术(GC-NOSES Ⅳ式)

doi:10.3877/cma.j.issn.1674-6899.2021.01.011

目的

经自然腔道取标本手术(natural orifice specimen extraction surgery，NOSES)具有美观、腹壁损伤小、术后疼痛轻等优势，笔者旨在探究机器人(Da Vinci Xi)在胃癌NOSES中的手术技巧及应用要点。

方法

选取南昌大学第一附属医院普外科1例胃癌病例，简介使用Da Vinci Xi手术机器人系统进行腹部无辅助切口经阴道取标本的远端胃切除术的手术步骤。

结果

手术顺利完成，术中及术后无并发症。

结论

经腹部无辅助切口经阴道取标本的远端胃切除术是安全、可行的，机器人的应用为手术的进行创造了极大的便利。

关键词: 胃癌, 机器人手术, 经自然腔道取标本手术

Objective

The technology of natural orifice specimen extraction surgery (NOSES) has the advantages of beautiful appearance, less abdominal wall damage and less postoperative pain, etc. This article was aimed to explore the surgical skills and application points of Da Vinci Xi surgical robot system in NOSES for gastric cancer.

Methods

A case of gastric cancer in the Department of General Surgery of the First Affiliated Hospital of Nanchang University was selected to explain the operation steps of Da Vinci Xi surgical robot system for distal gastrectomy without auxiliary incision through vagina.

Results

The operation was completed successfully, no complications occurred during and after the operation.

Conclusions

Transvaginal natural orifice specimen extraction distal gastrectomy without an auxiliary incision is safe and feasible, and the application of robotic surgery system creates convenience for the operation.

Key words: Gastric cancer, Robotic surgery, Natural orifice specimen extraction

图1 机械臂安装(上腹)

图2 腹部Trocar布局

图3 机械臂安装(下腹)

图4 经阴道取标本

图5 手术标本

图6 标本切开

图7 腹部引流管放置

1	Bray Freddie, Ferlay Jacques, Torre Lindsey A, et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]．CA: A cancer journal for clinicians, 2018, 68(6): 394-424.
2	Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system[J]. Surgical Endoscopy & Other Interventional Techniques, 2002, 16(8): 1187-1191.
3	Kim KM, An JY, Kim HI, et al. Major early complications following open, laparoscopic and robotic gastrectomy[J]. British Journal of Surgery, 2012, 99(12): 1681-1687.
4	Zhou J, Shi Y, Tang B, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes[J]. Surgical Endoscopy, 2014, 28(6): 1779-1787.
5	Haverkamp L, Ruurda JP, Offerhaus GJA, et al. Laparoscopic gastrectomy in western european patients with advanced gastric cancer[J]. European Journal of Surgical Oncology (EJSO), 2016, 42(1): 110-115.
6	Kim HI, Han SU, Yang HK, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma[J]. Annals of Surgery, 2016, 263(1): 103-109.
7	Zhang Shu, Jiang Zhi-Wei, Wang Gang, et al. Robotic gastrectomy with transvaginal specimen extraction for female gastric cancer patients[J] .World J Gastroenterol, 2015, 47(21): 142-148.
8	中国经自然腔道取标本手术联盟．胃癌经自然腔道取标本手术专家共识(2019版)[J]．中华胃肠外科杂志，2019，22(8)：711-714.
9	Taiyuan Li, Jianping Gong, Jinzhong Duanmu, et al.Improved Iaparoscopic transanal pull-through technique for low-rectal cancer resection[J]. Chinese-German Journal of Clinical Oncology, 2010, 9(10): 606-609.
10	Hu WG, Ma JJ, Zang L, et al. Learning curve and long-term outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 2014, 24(7): 487-492.
11	Kang BH, Yi X, Hur H, et al. Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: the learning curve of robotic surgery[J]. Journal of Gastric Cancer, 2012, 12(3): 156-163.
12	汤庆超，陈瑛罡，王锡山，等. 腹部无切口经阴道拉出切除标本的腹腔镜中位直肠癌根治术[J]. 中华胃肠外科杂志，2014, (12): 1233-1235.
13	谭华勇，潘凯，钟克力，等．腹腔镜直肠癌根治术标本取出方法对肛门功能影响的研究 [J/CD]. 中华腔镜外科杂志(电子版), 2012, 5(6): 446-450.
14	赵恩生，汤小龙，曲辉，等. 完全腹腔镜下经阴道取标本的胃癌根治术1例报告[J]. 腹腔镜外科杂志，2019, 24(1)：71-72.
15	刘金超，于刚，荣震. 经自然腔道取出标本的全腹腔镜远端胃癌根治术(Uncut Roux-en-Y吻合)七例报告[J/CD]. 中华结直肠疾病电子杂志，2018, 7(4)：381-384.
16	王松，于刚，赵旭，等. 腹部无辅助切口经阴道取标本的全腹腔镜全胃切除术(GC-NOSES Ⅷ式) (附视频)[J/CD]. 中华结直肠疾病电子杂志，2020, 9(1)：96-100.
17	余佩武，陈凛，曹晖，等. 机器人胃癌手术专家共识(2015版)[J]. 中国研究型医院，2016, 3(1)：22-28.

[1]	丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[2]	王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[3]	李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[4]	黄一博, 李至彦, 林晨, 陶亮, 王萌, 管文贤. 胃癌根治术中淋巴结示踪剂的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 586-588.
[5]	孙昭, 刘琪, 王殿琛, 姜建武, 符洋. 机器人对比腹腔镜及开放式腹股沟疝修补术的Meta 分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 588-598.
[6]	刘明昊, 李晨, 王冰, 万政, 田文. 机器人与腹腔镜食管裂孔疝修补术对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 376-382.
[7]	王鹏, 邵欣欣, 胡海涛, 田艳涛, 钟宇新. 改良MOBS 吻合法在全腹腔镜近端胃大部分切除中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 267-270.
[8]	魏孔源, 仵正, 王铮, 黎韡. 机器人胰腺中段切除后远端胰腺消化道不同重建方式初探[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 295-300.
[9]	胡海涛, 邵欣欣, 姜玉娟, 王鹏, 李维坤, 卢一鸣, 田艳涛. 十二指肠残端处理对全腹腔镜胃癌根治术后并发症的影响[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 205-209.
[10]	王泽钦, 洪军, 王雅平, 王健, 蒿汉坤. W型肝脏悬吊技术在全腹腔镜下全胃切除术中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 218-221.
[11]	曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243.
[12]	刘先勇, 秦东梅, 张若梅, 李俊娇, 孟春芹, 邬明歆, 王玉红, 赵新鲜, 徐瑞联, 洪文文, 马玲, 仇玮, 周宇. Her2/Hes1在肠型胃癌Correa级联反应3个病理阶段中的表达及意义[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(06): 321-327.
[13]	黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[14]	孙鹏, 陈瑛罡. 腹部无辅助切口经肛门取标本的腹腔镜下直肠癌根治术一例（附视频）[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 347-352.
[15]	甘曦, 廖鑫. 胃癌旁肿瘤沉积与CT影像学特征、血清指标及病理特征的关联性分析[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 422-425.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Transvaginal natural orifice specimen extraction robotic total distal gastrectomy without an auxiliary abdominal incision

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Transvaginal natural orifice specimen extraction robotic total distal gastrectomy without an auxiliary abdominal incision