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中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (06): 321 -325. doi: 10.3877/cma.j.issn.1674-6899.2021.06.001

论著    下一篇

单通道机器人肝胰手术初步临床实践与评价
刘荣1,(), 汪洋1, 赵国栋1, 柳俨哲1, 张修平1, 刘渠1, 李梦阳1   
  1. 1. 100853 北京,解放军总医院第一医学中心肝胆胰外科医学部
  • 收稿日期:2021-12-28 出版日期:2021-12-30
  • 通信作者: 刘荣

Preliminary clinical practice and evaluation of single-port robotic hepatopancreas surgery

Rong Liu1,(), Yang Wang1, Guodong Zhao1, Yanzhe Liu1, Xiuping Zhang1, Qu Liu1, Mengyang Li1   

  1. 1. Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2021-12-28 Published:2021-12-30
  • Corresponding author: Rong Liu
目的

探讨达芬奇单通道SP机器人在肝胰手术中的应用。

方法

使用达芬奇SP机器人平台,分别对1例胰尾囊腺瘤、1例肝左外叶肝癌、1例肝左叶混合型肝癌的患者实施了胰腺肿瘤剜除术、肝左外叶切除术、扩大肝左外叶切除+区域淋巴结清扫术。

结果

3例患者均成功的接受了单通道机器人手术。装机时间分别为20、14、9 min,镜下手术时间分别为55、49、76 min,总手术时间分别为100、83、105 min,术中出血量分别为5、10、20 ml,术后视觉疼痛模拟评分分别为3/10、3/10、3/10分,术后1 d视觉疼痛模拟评分分别为1/10、1/10、1/10分,3例患者均无并发症的发生。

结论

初步手术经验提示单通道机器人手术在欠复杂肝胆胰手术中是安全、可行的,较传统单孔手术优势显著,但仍待进一步经验积累和对比研究论证其临床价值,明确手术适应证。

Objective

Exploring the application of da Vinci single-channel SP robot in hepatopancreas surgery.

Methods

Using the da Vinci SP robotic platform, enucleation of pancreatic tumor, left lateral lobe resection, and enlarged left lateral lobectomy + regional lymph node dissection were performed on one patient with pancreatic tail cystadenoma, one patient with left lateral hepatic hepatic carcinoma, and one patient with mixed liver cancer in left hepatic lobe.

Results

All 3 patients successfully underwent single-channel robotic surgery. The installation time were 20, 14 and 9 minutes, the operation time were 55, 49 and 76 minutes, the total operation time were 100, 83 and 105 minutes, the blood loss were 5, 10 and 20 ml, and the postoperative visual analogue pain scale were 3/10, 3/10 and 3/10, the visual analogue pain scale on the first day after surgery were 1/10, 1/10 and 1/10, all 3 patients had no complications.

Conclusions

Preliminary surgical experience suggests that single-channel robotic surgery is safe and feasible in simple hepatobiliary and pancreatic surgery, and has significant advantages over traditional single-port surgery. However, further experience accumulation and comparative studies are needed to demonstrate its clinical value and clarify surgical indications.

图1 SP机器人胰腺囊腺瘤剜除术手术步骤注:A.SP机器人胰腺手术体外视野;B.离断胃结肠韧带;C.显露胰尾肿瘤;D.电钩剜除胰尾肿瘤;E.创面检查与电凝止血;F.术毕腹部切口及引流管
图2 SP机器人肝左外叶切除术手术步骤注:A.SP机器人肝左外叶切除布孔;B.助手使用超声刀离断肝实质,将Ⅱ/Ⅲ段肝蒂和左肝静脉粗分离;C.使用直线切割闭合器离断Ⅱ/Ⅲ段肝蒂;D.使用直线切割闭合器离断左肝静脉;E.手术创面;F.腹部切口
图3 SP机器人扩大肝左外叶切除术手术步骤注:A.SP机器人肝左外叶切除布孔;B.助手使用超声刀离断肝实质;C.助手使用直线切割闭合器依次离断Ⅱ/Ⅲ段肝蒂和左肝静脉;D.主刀清扫区域性淋巴结;E.手术创面;F.腹部切口
表1 围手术期指标
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