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中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 283 -287. doi: 10.3877/cma.j.issn.1674-6899.2023.05.006

论著

机器人手术在困难子宫切除术中的应用
顾成磊, 徐佳, 张妮娜, 赵路阳, 范文生()   
  1. 100700 北京,解放军总医院第七医学中心妇产医学部
  • 收稿日期:2023-08-15 出版日期:2023-10-30
  • 通信作者: 范文生

Application of robotic-assisted surgery in difficult hysterectomy

Chenglei Gu, Jia Xu, Nina Zhang, Luyang Zhao, Wensheng Fan()   

  1. Department of Obstetrics and gynecology, the Seventh Medical Center of Chinese PLA General Hospital, 100700 Beijing, China
  • Received:2023-08-15 Published:2023-10-30
  • Corresponding author: Wensheng Fan
引用本文:

顾成磊, 徐佳, 张妮娜, 赵路阳, 范文生. 机器人手术在困难子宫切除术中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(05): 283-287.

Chenglei Gu, Jia Xu, Nina Zhang, Luyang Zhao, Wensheng Fan. Application of robotic-assisted surgery in difficult hysterectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(05): 283-287.

目的

探讨机器人手术在困难子宫切除术中的应用价值与手术技巧。

方法

回顾性分析2021年4月至2023年6月于解放军总医院第七医学中心由同一术者实施的困难子宫切除术病例资料,描述患者的人口统计学特征、切除子宫参数、术中术后情况等临床数据。

结果

纳入的24例患者平均年龄为47.50岁,平均体质量指数(body mass index,BMI)为24.62 kg/m2,11例有腹部手术史,5例有肌瘤剔除史。术前评估子宫大小超出孕16周的患者占66.67%,术后测量子宫平均重量为752.58 g,最重者达2650 g。全部患者中位手术时间136.50 min,中位出血量150 ml, 1例患者中转开腹,患者术后均1~2 d排气,术后平均住院5.63 d。4例患者出现术后并发症,分别为阴道残端出血、气胸、下肢肌间血栓和残余卵巢综合征,无泌尿系和肠道损伤。

结论

机器人手术具有清晰放大的3D视野、灵活有力的机械臂和滤过震颤功能,在视野放大效果、操作的灵活性和稳定性上带来了革新,有助于降低出血量、减少并发症、加速术后恢复,因此在困难子宫切除中具有一定优势。

Objective

To discuss the application value of robotic-assisted surgery in difficult hysterectomy and summarize the surgical technique.

Methods

We retrospectively analyzed the hysterectomy cases performed by the same surgeon in the Seventh Medical Center of Chinese PLA General Hospital from Apr. 2021 to Jun. 2023. Clinical data such as demographic characteristics, parameters of uteri, and intraoperative and postoperative details was described.

Results

The average age of 24 patients was 47.50 years and the average BMI value was 24.62 kg/m2. 11 patients had a history of abdominal surgery and 5 had a history of myomectomy. 66.67% of the patients were found uterine size exceeding 16 weeks of pregnancy before surgery, and the average weight of the uteri measured after surgery was 752.58 g, with the maximum weight reaching 2650 g. The median operation time of all patients was 136.50 min, and the median bleeding volume was 150 ml. Only 1 patient was converted to laparotomy. The postoperative venting time was 1-2 days, and the mean length of postoperative hospital stay was 5.63 days. The complications in 4 patients included vaginal stump bleeding, pneumothorax, lower limb intermuscular thrombosis and residual ovarian syndrome. No patient had urinary and intestinal injuries.

Conclusions

Surgical robot has a clear and enlarged 3D field of view, a flexible and powerful robotic arm with the function of filtering tremors, which brings innovations in field of view amplification, operational flexibility and stability. It could help to decrease blood loss, reduce complications and accelerate postoperative recovery, so it has certain advantages in difficult hysterectomy.

表1 人口统计学特征
表2 切除子宫参数
图1 手术关键步骤注:A.暴露术野,探查子宫;B.凝断右侧圆韧带;C.下推膀胱反折腹膜;D.凝闭左侧子宫血管;E.环形切开阴道壁;F.缝合阴道断端;G.3号臂下压子宫;H.削苹果法缩小子宫体积。
表3 术中术后相关指标
1
Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease[J]. Cochrane Database Syst Rev, 2015, 2015(8):CD003677.
2
Kim S, Luu TH, Llarena N, et al. Role of robotic surgery in treating fibroids and benign uterine mass[J]. Best Pract Res Clin Obstet Gynaecol, 2017, 45:48-59.
3
Mohammed WE, Salama F, Tharwat A, et al. Vaginal hysterectomy versus laparoscopically assisted vaginal hysterectomy for large uteri between 280 and 700 g: a randomized controlled trial[J]. Arch Gynecol Obstet, 2017, 296(1):77-83.
4
Wright JD, Ananth CV, Lewin SN, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease[J]. JAMA, 2013, 309(7):689-698.
5
Palep JH. Robotic assisted minimally invasive surgery[J]. J Minim Access Sur, 2009, 5(1):1-7.
6
Varghese A, Doglioli M, Fader AN. Updates and controversies of robotic-assisted surgery in gynecologic surgery[J]. Clin Obstet Gynecol, 2019, 62(4):733-748.
7
Carbonnel M, Moawad GN, Tarazi MM, et al. Robotic hysterectomy for benign indications: what have we learned from a decade?[J]. JSLS, 2021, 25(1):e2020.00091.
8
Macciò A, Chiappe G, Kotsonis P, et al. Feasibility and safety of total laparoscopic hysterectomy for uteri weighing from 1.5 kg to 11.000 kg[J]. Arch Gynecol Obstet, 2021, 303(1):169-179.
9
Uccella S, Casarin J, Marconi N, et al. Laparoscopic versus open hysterectomy for benign disease in women with giant uteri (≥1500 g): feasibility and outcomes[J]. J Minim Invasive Gynecol, 2016, 23(6):922-927.
10
Uccella S, Cromi A, Serati M, et al. Laparoscopic hysterectomy in case of uteri weighing ≥1 kilogram: a series of 71 cases and review of the literature[J]. J Minim Invasive Gynecol, 2014, 21(3):460-465.
11
Akazawa M, Lee SL, Liu WM. Impact of uterine weight on robotic hysterectomy: a analysis of 500 cases in a single institute[J]. Int J Med Robot, 2019, 15(5):e2026.
12
Louie M, Strassle PD, Moulder JK, et al. Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy[J]. Am J Obstet Gynecol, 2018, 219(5):480.e1-480.e8.
13
Leonardi M, Robledo KP, Gordijn SJ, et al. A consensus-based core feature set for surgical complexity at laparoscopic hysterectomy[J]. Am J Obstet Gynecol, 2022, 226(5):700.e1-700.e9.
14
张海艳,王楠,范文生,等. 机器人手术大子宫切除的临床对比研究[J]. 现代妇产科进展2020, 29(1):55-57,61.
15
Silasi DA, Gallo T, Silasi M, et al. Robotic versus abdominal hysterectomy for very large uteri[J]. JSLS, 2013, 17(3):400-406.
16
洪莎莎,徐玮晨,洪莉. 机器人辅助系统与腹腔镜下大子宫切除术后并发症比较及分析[J]. 中国计划生育和妇产科2021, 13(12):78-82.
17
Uccella S, Morosi C, Marconi N, et al. Laparoscopic versus open hysterectomy for benign disease in uteri weighing >1 kg: a retrospective analysis on 258 patients[J]. J Minim Invasive Gynecol, 2018, 25(1):62-69.
18
Kaaki B, Lewis E, Takallapally S, et al. Direct cost of hysterectomy: comparison of robotic versus other routes[J]. J Robot Surg, 2020, 14(2):305-310.
19
Gupta N, Mohling S, Mckendrick R, et al. Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g[J]. J Robot Surg, 2018, 12(4):641-645.
20
Haber HR, Namazi G, Pepin K, et al. Minimally invasive surgical techniques for tissue extraction[J]. J Minim Invasive Gynecol, 2021, 28(3):388.
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