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中华腔镜外科杂志(电子版) ›› 2025, Vol. 18 ›› Issue (04) : 193 -197. doi: 10.3877/cma.j.issn.1674-6899.2025.04.001

指南与共识

机器人辅助单孔妇科手术中国专家共识(2025年版)
中华医学会妇产科分会妇科内镜学组   
  1. 1. 100730 北京协和医院妇产科
    2. 100853 北京,解放军总医院第七医学中心妇产科医学部
  • 收稿日期:2025-07-26 出版日期:2025-08-30
  • 基金资助:
    国家重点研发计划(2023YFC2413400); 中央高水平医院临研专项提升项目(2022-PUMCH-B-086); 单孔腔镜手术系统产学研合作项目(FW-HXKT202209160165)

Chinese expert consensus on robotic-assisted single-port gynecological surgery (2025 Edition)

Gynecological Endoscopy Group, Obstetrics and Gynecology Branch, Chinese Medical Association   

  1. 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 100730, China
    2. The Department of Obstetrics and Gynecology of the Seventh Medical Center of the PLA General Hospital, Beijing 100853, China
  • Received:2025-07-26 Published:2025-08-30
引用本文:

中华医学会妇产科分会妇科内镜学组. 机器人辅助单孔妇科手术中国专家共识(2025年版)[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(04): 193-197.

Gynecological Endoscopy Group, Obstetrics and Gynecology Branch, Chinese Medical Association. Chinese expert consensus on robotic-assisted single-port gynecological surgery (2025 Edition)[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(04): 193-197.

为进一步规范机器人辅助单孔手术在妇科领域的应用,提升其操作安全性和临床效果,本专家共识系统总结了相关技术现状、适应证和禁忌证及操作规范。近年来,随着内窥镜技术的进步,机器人辅助单孔腹腔镜手术(robot-assisted laparoendoscopic single-site surgery, R-LESS)显著提升了妇科手术在狭窄空间内的操作灵活性、精准度和术者舒适度。共识详细阐述了多臂及单臂机器人系统(如达芬奇Si/Xi/SP、国产术锐SR-ENS-600和精锋SP1000)的技术特点与临床应用,明确了包括附件手术、子宫切除术及早期恶性肿瘤手术在内的适应证与禁忌证,规范了术前评估、患者准备、手术步骤及并发症防治要点。最后,展望了R-LESS在人工智能辅助规划、5G远程操作、力反馈技术与规范化培训等方面的未来发展方向。

To further standardize the application of robotic assisted single-port surgery in gynecology and enhance its operational safety and clinical outcomes, this expert consensus systematically summarizes the current technological status, indications, contradiction and operational protocols. In recent years, with advancements in endoscopic technology, robot-assisted laparoendoscopic single-site surgery (R-LESS) has significantly improved operational flexibility, precision, and surgeon comfort in gynecological procedures within confined spaces. The consensus elaborates on the technical features and clinical applications of multi-arm and single-arm robotic systems (such as da Vinci Si/Xi/SP, and domestically developed Shurui SR-ENS-600 and Jingfeng SP1000), defines the indications and contraindications including adnexal surgery, hysterectomy, and early-stage malignant tumor surgery, and standardizes key aspects of preoperative assessment, patient preparation, surgical steps, and complication management. Finally, it outlines future directions for R-LESS in AI-assisted planning, 5G remote operation, force feedback technology, and standardized training.

表1 常用单臂机器人系统产品参数对比
  da Vinci SP 术锐SR-ENS-600 精锋SP1000
手术工具驱动原理 钢丝绳驱动型 可形变对偶连续体型 钢丝绳驱动型
内窥镜 内窥镜为多关节机械臂结构,末端相机倾角为固定0度,相机集成了感光成像芯片,通过线缆将视频信号传输至成像系统。 采用连续体机构实现6自由度的可翻展运动,单构节可弯转90°。集成两路CMOS感光芯片,通过线缆将视频信号传输至成像系统 内窥镜为多关节机械臂结构,具备6个自由度,末端可实现多个不同角度的相机倾角。集成了两路CMOS感光成像芯片,通过线缆将视频信号传输至成像系统。
单孔术式实现原理 通过定位臂摆位,定位臂与鞘管相连,然后多关节手术工具机械臂和内窥镜机械臂通过该鞘管从单个皮肤切口进入。 各定位臂与一个多通道鞘管相连,手术工具和内窥镜凭借其自身柔性,经鞘管通道进入病人体内。 手术工具和机械臂集成在一个机械臂里,单臂通道进入人体后,展开1镜和三个工具。
支持器械数目 3支手术臂+ 1支视觉臂 3支手术工具+ 1支内窥镜 3支手术工具+1支内窥镜
手术工具自由度 多关节机械臂具有计6个自由度实现空间位姿的调节;另1个自由度控制夹钳开合。 手术工具具有6个自由度实现空间位姿的调节;另1个自由度控制夹钳开合。 多关节机械臂具有6个自由度实现空间位姿的调节;另1个自由度控制夹钳开合。
单臂负载能力 约2N(无公开数据) 不小于10N 7N
1
Escobar PF, Haber GP, Kaouk J, et al. Single-port surgery: laboratory experience with the Da Vinci single-site platform[J]. JSLS, 201115(2):136-141.
2
Autorino R, Kaouk JH, Stolzenburg JU, et al. Current status and future directions of robotic single-site surgery: a systematic review[J]. Eur Urol, 2013, 63(2):266-280.
3
Douissard J, Hagen ME, Morel P.The da Vinci surgical system[J]. Bariatric Robotic Surgery2019.
4
Panattoni A, Giannini A, Morganti R, et al. Perioperative outcomes of the first five cases of surgeries for endometrial endometrioid cancer using the new integrated table motion for Da Vinci Xi®[J]. Int J Med Robot, 2021, 17(4):e2254.
5
Ferguson JM, Pitt B, Kuntz A, et al. Comparing the accuracy of the Da Vinci Xi and da Vinci Si for image guidance and automation[J]. Int J Med Robot, 2020, 16(6):1-10.
6
Ngu JC, Tsang CB, Koh DC. The Da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery[J]. Robot Surg, 2017, 4:77-85.
7
Shin HJ, Yoo HK, Lee JH, et al. Robotic single-port surgery using the da Vinci SP® surgical system for benign gynecologic disease: a preliminary report[J]. Taiwan J Obstet Gynecol, 2020, 59(2):243-247.
8
Lee SR, Roh AM, Jeong K, et al. First report comparing the two types of single-incision robotic sacrocolpopexy: single site using the Da Vinci Xi or Si system and single port using the Da Vinci SP system[J]. Taiwan J Obstet Gynecol, 2021, 60(1):60-65.
9
Iavazzo C, Minis EE, Gkegkes ID. Single-site port robotic-assisted hysterectomy:an update[J]. J Robot Surg, 201812(2):201-213.
10
Ren C, Sun DW. Robot-assisted single-port laparoscopic bilateral ovarian cystectomy using the Shurui® system: a case report[J]. Intelligent Surgery20223:9-13.
11
Chang R, Ping D, Yang S, et al. Effectiveness and safety of SR-ENS-600endoscopic surgical system in benign and malignant gynecological diseases: a prospective, multicenter, clinical trial with 63 cases[J]. J Robot Surg, 2024, 18(1):210.
12
Hu X, Ruan M, Zhu L, et al. This is the first in-human trial and prospective case series of a novel single-port robotic system for gynaecological surgery: an IDEAL stage 2a study[J]. Int J Med Robot, 2024, 20(5):e2657.
13
Mei Y, Wang Y, Zhang Q, et al. Gasless transvaginal natural orifice transluminal endoscopic surgery for hysterectomy and salpingectomy on a robot platform with flexible devices in a porcine model[J]. Sci Rep, 2024, 14(1):5366.
14
张同乐,叶明侠,王铭洋,等. 国产单孔机器人辅助腹腔镜下卵巢畸胎瘤剥除术临床试验:国内首例报道[J]. 机器人外科学杂志(中英文), 2023, 4(3):258-263.
15
Gong P, Mao H, He T, et al. Initial outcomes and methodologies of a novel single-port robotic surgery in gynecology[J]. JSLS, 2024, 28(4):e2024.00047.
16
Gungor M, Kahraman K, Ozbasli E, et al. Ovarian cystectomy for a dermoid cyst with the new single-port robotic system[J]. Minim Invasive Ther Allied Technol, 2015, 24:123-126.
17
Gargiulo AR, Feltmate C, Srouji SS. Robotic single-site excision of ovarian endometrioma[J]. Fertil Res Pract, 2015, 1:19.
18
Paek J, Lee JD, Kong TW, et al. Robotic single-site versus laparoendoscopic single-site surgery for adnexal tumours: a propensity score-matching analysis[J]. Int J Med Robot, 2016, 12:694-700.
19
Liu Z, Tian S, Yan Z, et al. Robotic single-site surgery for mature cyst teratoma cystectomy: an initial case series study in a single medical center in China[J]. Therapeut Clin Risk Manag, 2019, 15:179-185.
20
Kim S, Min KJ, Lee S, et al. Robotic single-site surgery versus laparoendoscopic single-site surgery in ovarian cystectomy: a retrospective analysis in single institution[J]. Gynecologic Robotic Surgery, 2020, 1:21-26.
21
Advincula AP, Song A, Burke W, et al. Preliminary experience with robotic-assisted laparoscopic myomectomy[J]. J Am AssocGynecol Laparosc, 2004, 11(4):511-518.
22
Gunnala V, Setton R, Pereira N, et al. Robot-assisted myomectomy for large uterine myomas: a single center experience[J]. Minim Invasive Surg, 2016, 2016:4905292.
23
Sangha R, Strickler R, Dahlman M, et al. Myomectomy to conserve fertility: seven-year follow-up[J]. J Obstet Gynaecol Can, 2015, 37(1):46-51.
24
Lee SR, Kim JH, Lee YJ, et al. Single-incision versus multiport robotic myomectomy: a propensity score matched analysis of surgical outcomes and surgical tips[J]. J Clin Med, 2021, 10(17):3957.
25
Misal M, Magtibay PM, Yi J. Robotic LESS and reduced-port hysterectomy using the Da Vinci SP surgical system: a single-institution case series[J]. J Minim Invasive Gynecol, 2021, 28(5):1095-1100.
26
Matanes E, Boulus S, Lauterbach R, et al. Robotic laparoendoscopic single-site compared with robotic multi-port sacrocolpopexy for apical compartment prolapse[J]. Am J Obstet Gynecol, 2020, 222(4):358,e1-e11.
27
Lee JH, Yoo HK, Park SY,et al. Robotic single-port myomectomy using the Da Vinci SP surgical system: a pilot study[J]. J Obstet Gynaecol Res, 2022, 48(1):200-206.
28
Huang Y, Duan K, Koythong T, et al. Application of robotic single-site surgery with optional additional port for endometriosis: a single institution′s experience[J]. J Robot Surg, 2022, 16(1):127-135.
29
Kanno K, Andou M, Sawada M, et al. Segmental bowel resection for rectal endometriosis using the da Vinci SP[J]. J Minim Invasive Gynecol, 2025, 32(1):14.
30
Corrado G, Mereu L, Bogliolo S, et al. Robotic single site staging in endometrial cancer: a multi-institution study[J]. Eur J Surg Oncol, 2016, 42:1506-1511.
31
Kwak YH, Lee H, Seon K, et al. Da Vinci SP single-port robotic surgery in gynecologic tumors: single surgeon′s initial experience with 100 Cases[J]. Yonsei Medical Journal, 2022, 63(2):179.
32
Kang H, Chung H, Lee S, et al. Comparison of long-term outcomes in early-stage endometrial cancer: robotic single-site vs. multiport laparoscopic surgery[J]. J Pers Med, 2024, 14(6):601.
33
Gao J, Dang J, Chu J, et al. A comparative analysis of robotic single-site surgery and laparoendoscopic single-site surgery as therapeutic options for stage IB1 cervical squamous carcinoma[J]. Cancer Manag Res, 2021, 13:3485-3492.
34
Jang TK, Chung H, Kwon SH, et al. Robotic single-site versus multiport radical hysterectomy in early stage cervical cancer: An analysis of 62 cases from a single institution[J]. Int J Med Robot, 2021, 17(4):e2255.
35
Yoo JG, Kim WJ, Lee KH. Single-site robot-assisted laparoscopic staging surgery for presumed clinically early-stage ovarian cancer[J]. J Minim Invasive Gynecol, 2018, 25(3):380-381.
36
Lee CL, Wu KY, Su H, et al. Robot-assisted natural orifice transluminal endoscopic surgery for hysterectomy[J]. Taiwan J Obstet Gynecol, 2015, 54(6):761-765.
37
Yang YS. Robotic natural orifice transluminal endoscopic surgery (NOTES) hysterectomy as a scarless and gasless surgery[J]. Surg Endosc, 2020, 34(1):492-500.
38
Koythong T, Thigpen B, Sunkara S, et al. Surgical outcomes of hysterectomy via robot-assisted versus traditional transvaginal natural orifice transluminal endoscopic surgery[J]. J Minim Invasive Gynecol, 2021, 28(12):2028-2035.
39
王景涛,黄桔园,邓鹏瀚,等. 第四代达芬奇机器人Xi系统辅助经阴道自然腔道内镜手术在妇科中的应用效果[J]. 武汉大学学报(医学版), 202445(2):47-151,179.
40
刘娟,肖媛月,王倩青,等. 盆腔器官脱垂手术新入路:机器人辅助经阴道腹腔镜阴道骶骨固定术[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(3):168-171.
41
Nulens K, Kempenaers R, Baekelandt J. Hysterectomy via vaginal Natural Orifice Transluminal Endoscopic Surgery in virgin patients: a first feasibility study[J]. J Obstet Gynaecol, 2022, 42(1):116-121.
42
孙大为. 经阴道腹腔镜手术的探索与实践[M]. 北京:清华大学出版社,2019:23-26.
43
Park JY, Kim TJ, Kang HJ, et al. Laparoendoscopic single site (LESS) surgery in benign gynecology: perioperative and late complications of 515 cases[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 167(2):215-218.
44
公丕军,毛会,白莉,等.可弯曲单孔机器人临床应用研究及展望[J/OL].中华腔镜外科杂志(电子版), 2023, 16(5):315-320.
45
Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors- an up-to-date review[J]. Wideochir Inne Tech Maloinwazyjne, 2021, 16(3):501-525.
46
Glaser LM, Milad MP. Bowel and bladder injury repair and follow-up after gynecologic surgery[J]. Obstet Gynecol, 2019, 133(2):313-322.
47
中国医师协会微无创医学单孔与阴道腔镜学组,郑莹,熊光武,等.经脐单孔腹腔镜手术脐部切口管理专家共识(2022年版)[J].实用妇产科杂志2022, 38(3):192-197.
48
孙昊,党建红,李月明,等. 5G远程机器人辅助单孔腹腔镜妇科手术1例应用实践[J].海军医学杂志2025, 46(3):268-272.
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