机器人与传统腹腔镜手术治疗早期上皮性卵巢癌的临床对比研究

目的:对比分析机器人与传统腹腔镜手术治疗早期上皮性卵巢癌的优缺点及预后价值。 方法:收集 2016 年 5 月至 2020 年 11 月于郑州大学第一附属医院治疗的 73 例早期(FIGOⅠ ~ Ⅱ期) 上皮性卵巢癌患者的临床资料,其中机器人辅助下腹腔镜手术 30 例(机器人组),传统腹腔镜手术 43 例(腹腔镜组)。 比较两组术中、术后相关指标和远期疗效。 结果:①两组患者均顺利完成手术, 无中转开腹。 与腹腔镜组比较,机器人组的手术时间长、术中出血量少、术中切除淋巴结数多、手术 费用较高、术后 24 小时腹腔引流量少,差异均有统计学意义(P < 0. 05);②对机器人助手(8 人)调 查发现:操作便利性满意(87. 5% )、器械连接与装配满意(75. 0% )及学习难度满意(87. 5% ),与主刀 配合时的难易度及手术系统转运满意率均为 62. 5% ,而舒适度的满意率为 50. 0% ;③在随访期内,两组 患者的复发率及无进展生存期比较,差异无统计学意义(P >0. 05)。 结论:机器人辅助腹腔镜全面分期 手术治疗早期上皮性卵巢癌具有减少术中出血量、术中切除淋巴结多、腹腔引流量少的优势,但存在助 手配合有难度、花费高等缺点,随着技术的革新,合理选择患者的条件下,机器人手术治疗早期上皮性 卵巢癌具有优越性。     

达芬奇机器人手术系统在早期卵巢癌分期手术中的应用价值研究

目的探讨达芬奇机器人手术系统在早期卵巢癌中的应用价值。方法回顾性分析郑州大学第一附属医院2013年10月至2016年8月开展的15例机器人辅助下早期卵巢癌分期手术与20例传统腹腔镜下早期卵巢癌分期手术的患者资料,比较两组患者手术时间、术中出血量、术中切除淋巴结数目、术中及术后并发症、术后排气时间、术后平均住院日等指标。结果两组患者均顺利完成早期卵巢癌全面分期手术。机器人组术中出血量、术后平均住院日均少于传统腹腔镜组,切除淋巴结数目、手术时间大于传统腹腔镜组(P0.05)。两组术后排气时间差异无统计学意义(P0.05)。病理结果显示:机器人组8例浆液性囊腺癌,3例黏液性囊腺癌,3例交界性囊腺瘤,1例未成熟性畸胎瘤。传统腹腔镜组12例浆液性囊腺癌,5例黏液性囊腺癌,2例交界性囊腺瘤,1例颗粒细胞瘤。两组均无中转开腹,均无术中、术后并发症发生。结论达芬奇机器人手术系统在早期卵巢癌分期手术中的临床应用安全可行,具有一定的优越性,可成为早期卵巢癌分期手术的新选择。     

计算机辅助下的腹腔镜手术在妇科的应用进展

计算机辅助下的腹腔镜手术(也称达芬奇机器人手术系统)的出现将微创化技术带入了机器人手术时代.目前已经有大量的将机器人手术成功应用于妇科良性和恶性疾病的报道,包括子宫切除术、子宫肌瘤剥除术、输卵管吻合术、卵巢移位术、盆底重建术,以及子宫内膜癌、宫颈癌和卵巢癌的手术治疗.机器人手术系统比较普通的腹腔镜手术具有更大的精确性和灵活性以及清晰的三维视野等独特优点,但是缺乏触觉反馈和费用高昂的缺点也是其推广过程中的限制因素.     

机器人手术系统与腹腔镜在卵巢癌手术中应用效果的meta分析

目的:系统评价机器人手术系统在卵巢癌手术中的有效性和安全性。方法:检索Pubmed、Embase、Cochrane Library、Web of Science、CNKI、CBM和万方数据库从建库至2018年5月1日的文献,对所纳入的研究,运用Revman 5.3软件进行meta分析。结果:最终纳入9篇文献,受试患者共404例(机器人组178例,腹腔镜组226例)。Meta分析结果显示,与腹腔镜组相比,机器人手术系统可显著减少术中出血量,在早期卵巢癌手术中手术时间长于腹腔镜组,尚未发现两种手术方式在其他方面的明显差异。结论:在卵巢癌尤其是早期卵巢癌手术中,机器人手术系统在近期疗效上存在一定优势,但其远期疗效仍需进一步研究。     

原发盆腔腹膜后肿瘤机器人辅助腹腔镜与传统腹腔镜手术并发症的比较及危险因素分析

目的:探讨机器人辅助腹腔镜手术及传统腹腔镜手术治疗女性原发性盆腔腹膜后肿瘤手术并发症的发生情况,并分析影响手术并发症的相关危险因素。方法:回顾收集2017年12月至2022年4月在郑州大学第一附属医院接受手术治疗的104例女性原发性盆腔腹膜后肿瘤患者的临床病例资料,根据手术方式不同分为机器人组(采用机器人系统辅助腹腔镜手术,33例)和腹腔镜组(采用传统腹腔镜手术,71例),比较两组患者手术并发症的发生率及严重程度的差异,并对影响手术并发症发生的相关因素进行单因素及多因素logistic回归分析。结果:相较于腹腔镜组,机器人组围术期总并发症少(9.1%vs 26.8%),术中并发症较少(3.0%vs 21.1%),差异有统计学意义(P<0.05)。两组患者的术后并发症及严重并发症比较,差异无统计学意义。单因素分析显示,肿瘤性质、手术时间、中转其他术式、加权切除器官评分及手术方式与女性PPRT患者手术并发症发生相关。多因素分析显示,肿瘤性质、手术时间、加权切除器官评分及手术方式是女性PPRT患者手术并发症发生的独立危险因素(P<0.05)。结论:机器人辅助腹腔镜手术较传统腹腔镜...     

达芬奇机器人及传统腹腔镜子宫肌瘤剥除术的比较

目的:探讨达芬奇机器人手术系统辅助腹腔镜用于子宫肌瘤剥除术的优势。方法:选取2012年5月至2014年5月采用达芬奇机器人辅助腹腔镜行子宫肌瘤剥除术的20例患者作为研究组,同时选取2013年5月至2014年5月在传统腹腔镜下行子宫肌瘤剥除术的20例患者作为对照组。比较两组患者的术中出血量、手术时间、术后肠道功能恢复时间、术后平均住院日、医生满意度评分、下床活动时间、剔除肌瘤数、肌瘤平均直径、术后24h腹腔引流量等。结果:达芬奇智能臂辅助腹腔镜子宫肌瘤剥除术在术后肠道功能恢复时间、术后平均住院日、医生满意度评分、下床活动时间等方面优于传统腹腔镜手术(P0.05);两组手术时间比较,差异无统计学意义(P0.05)。结论:达芬奇机器人辅助腹腔镜手术比传统腹腔镜手术具有缝合牢固、出血少、恢复快等优势。     

子宫内膜癌微创手术的研究进展

医学模式转变为微创外科的发展带来了机遇,随着科学及医疗技术的不断创新,近二十年来微创技术迅速发展,应用于妇科肿瘤领域并取得了满意的效果。其具有手术切口比较小、术中出血量少、并发症的发生率低及住院时间和恢复时间短等优点。不仅如此,与传统的开腹手术相比,子宫内膜癌微创手术的淋巴结切除数目、患者整体生存率、无瘤生存期等指标无明显差异。因此微创手术治疗子宫内膜癌是安全可行的。目前可用于治疗子宫内膜癌的微创技术包括传统腹腔镜、单孔腹腔镜、机器人手术系统以及机器人辅助单孔腹腔镜技术等。现对各种微创技术在子宫内膜癌中的应用及其优劣性作一介绍,希望能为临床工作者根据患者情况选择手术方式提供一定的帮助。     

腹腔镜手术在晚期卵巢癌中的应用现状与争议

目前,卵巢癌的死亡率仍居女性生殖系统恶性肿瘤首位,成功的手术治疗是提高卵巢癌临床疗效的关键之一.腹腔镜手术应用于早期卵巢癌的分期手术已无分歧,但目前关于腹腔镜手术在晚期卵巢癌中的应用还存在争议.腹腔镜虽然具有自身微创等优势,但还不能作为晚期卵巢癌常规的治疗方法;对于晚期卵巢癌患者,应在不影响其生存率的前提下尽量改善其术后生存质量.     

腹腔镜手术应用于卵巢恶性肿瘤的进展及前景

腹腔镜手术在Ⅰ期卵巢癌患者首次和再次分期手术中,在二探手术中识别卵巢癌微转移以及在评估进展期卵巢癌行最佳细胞减灭术机会中的应用进展,可望为卵巢癌的治疗提供新途径。同时,腹腔镜手术后出现的穿刺部位卵巢癌细胞种植和转移、手术自身的限制和手术操作难度的增加,对腹腔镜手术的应用提出了挑战。随着腹腔镜操作技巧的提高,穿刺部位卵巢癌细胞种植和转移现象明显降低。同时,腹腔镜技术与多学科交叉共同发展,将为其在卵巢癌治疗中的应用开辟更广阔的天地。     

达芬奇机器人在7例早期卵巢癌分期手术中的临床应用

目的:初步探讨达芬奇机器人在早期卵巢癌分期手术临床应用中的安全性及可行性。方法:回顾分析郑州大学第一附属医院2014年10月至2015年3月为7例患者采用达芬奇机器人行早期卵巢癌分期手术的临床资料。结果:7例采用达芬奇机器人行早期卵巢癌分期手术的患者,平均手术时间299.29±52.63分钟,术中平均出血量90.71±18.13 ml,平均切除盆腔及腹主动脉旁淋巴结个数28.57±2.37个,术后平均肛门排气时间1.79±0.57天,术后平均住院时间9.29±1.80天。病理检查结果显示:4例为卵巢浆液性囊腺癌,1例为黏液性囊腺癌,2例为交界性囊腺瘤局部恶变,其中1例腹腔冲洗液发现恶性细胞。7例达芬奇机器人手术均无中转开腹、肠道及泌尿系损伤、术中血管损伤及术后盆腹腔渗血、出血等并发症。结论:达芬奇机器人手术在早期卵巢癌分期手术中的临床应用有一定可行性和安全性。     

Role of Minimally Invasive Surgery in Ovarian Cancer

The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic-assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology.     

腹腔镜手术中的卵巢功能保护

腹腔镜手术治疗效果好,术后恢复快,伤口美观,已逐步取代绝大多数传统手术,成为目前妇科使用最广泛、发展前景良好的微创手术。在施行妇科腹腔镜手术的过程中,各类手术操作是否会影响卵巢功能,导致卵巢储备功能下降甚至卵巢功能早衰,成为近年来备受关注的问题。正确认识和使用腹腔镜能量器械,有助于腹腔镜技术的健康发展。现从卵巢的解剖、卵巢储备功能检测、腹腔镜手术对卵巢功能的影响以及腹腔镜手术时卵巢保护措施等方面进行阐述,指出把握正确的手术指征,选择恰当的手术方式,掌握熟练的手术技巧,对保护卵巢功能有重要的意义。     

腹腔镜在卵巢癌诊治中的应用

腹腔镜技术在卵巢癌诊断和治疗中的应用价值一直饱受争议。随着微创观念的不断强化以及微创外科技术的不断发展,腹腔镜下早期卵巢癌全面分期手术已逐步得到学术界的认同和推崇。临床晚期卵巢癌通过腹腔镜检查进行诊断并评估肿瘤细胞减灭术的可行性和彻底性,也正受到广泛关注和踊跃尝试。但在腹腔镜下完成晚期卵巢癌的肿瘤细胞减灭术,其可行性、有效性和安全性仍然受到强烈质疑。有限的临床实践提示,只要病例选择和技术应用得当,大部分的晚期卵巢癌患者仍然可以从腹腔镜等微创技术的应用中获益,值得深入研究。     

腹腔镜下自体组织修复手术在纠正女性盆腔器官脱垂中的应用

腹腔镜手术在妇科领域应用广泛,近来更是成熟应用于女性盆底功能障碍性疾病的诊治中。在经阴道网片修复手术应用受限的背景下,自体组织修复的盆底重建术再次受到重视。相对于经阴道途径,腹腔镜下的自体组织修复手术报道相对较少,但随着腹腔镜技术、设备以及机器人手术等领域的创新,腹腔镜下的盆底重建手术也定将得到进一步发展。文章就腹腔镜下自体组织修复手术在纠正女性盆腔器官脱垂中的应用做一综述,为妇科医师选择术式提供参考。     

Laparoscopic treatment of early ovarian cancer

PURPOSE OF REVIEW: Recently some studies have reinforced the arguments supporting the laparoscopic management of early ovarian cancer. These studies and reports questioning the use of laparoscopy in patients with early ovarian cancer will be reviewed. RECENT FINDINGS: Advances in laparoscopic techniques have enabled the surgeon to meet the staging criteria for early ovarian cancer as proposed by the International Federation of Gynecology and Obstetrics (FIGO) guidelines. Although some reports highlight the risk of ovarian cancer mismanagement, the safety and reliability of laparoscopic surgical staging has been demonstrated with encouraging results. However, the numbers of patients included in these studies are still insufficient to draw conclusions. SUMMARY: Clinical evidence supports the use of laparoscopy in the treatment or completion of treatment in patients diagnosed with early ovarian cancer. If strict guidelines are respected, tumor rupture, dissemination and implant on the trocar insertion sites can be avoided and survival outcomes appear not to be jeopardized. Inadequate and hazardous laparoscopic management of early ovarian cancer is to be ascribed to the lack of guidelines and to surgeons without the competence to treat early ovarian cancer rather than to the surgical technique. The excellent outcomes could encourage studies with larger sample sizes to confirm the validity of laparoscopic treatment of patients with early ovarian cancer. Unfortunately, a clinical trial is unlikely to be undertaken due to the low incidence of this disease and the even lower number of events.     

Management of adnexal tumors: role and risks of laparoscopy

The laparoscopic management of adnexal tumeurs remains controversial because of the potentials risks of cancer dissemination suggested by many case reports and national surveys. From experimental data, the laparoscopic treatment of gynecologic cancer has potential advantages and disadvantages. The risk of dissemination appears high when a large number of malignant cells are present so that adnexal tumors with external vegetations, and bulky lymph nodes may be considered as contra-indications to CO2 laparoscopy. Laparoscopic surgery has become the gold standard in the treatment of benign adnexal tumeurs, whereas laparotomy remains the standard for the treatment of malignant tumors. The surgical diagnosis is the key to adequate management of adnexal tumeurs. In our experience, after a careful preoperative evaluation, the laparoscopic diagnosis of malignancy is reliable. Moreover in national surveys, many malignant tumeurs were considered as benign despite suspicious laparoscopic findings. Using strict guidelines, laparoscopic diagnosis can be proposed for both non suspicious and complex tumeurs, thus avoiding many unnecessary laparotomies for benign tumeurs suspicious at ultrasound. The more controversial limits of laparoscopic treatment are discussed. If a laparotomy was performed for all tumeurs suspicious at surgery, 80% of the cases would be treated by laparoscopy. The role of laparoscopy for restaging and second look operations for ovarian cancer requires further evaluation.     

Laparoskopie in der gynäkologischen Onkologie

Background

Laparoscopy is increasingly being used for operative treatment of gynecological malignancies.

Aim

This article supplies answers to the following questions: what are the indications in gynecological oncology for laparoscopic operations? Does one of the open surgical procedures offer comparable oncological safety?

Material and methods

An analysis of the literature was carried out with respect to prospective randomized trials. This article summarizes the important publications on endoscopic operative procedures for endometrial, cervical and ovarian cancer as well as borderline ovarian tumors.

Results

Operative treatment of early stage endometrial and cervical cancer can be carried out using laparoscopy, including pelvic and para-aortic lymphadenectomy. The current data suggest that there is comparable oncological safety between laparoscopy and laparotomy. Surgical staging can be used to assess the retroperitoneal para-aortic lymph node status before chemoradiation of locally advanced cervical cancer. Operative treatment of early stage ovarian cancer should be carried out via midline incision laparotomy because of a superior evaluation of the bowels, retroperitoneum and upper abdomen. Laparoscopy plays an important role in the diagnostics of cancer of unknown primary (CUP) syndrome and to acquire tissue biopsies before neoadjuvant chemotherapy. Borderline ovarian tumors can be treated laparoscopically without impairing patient prognosis.

Conclusions

Laparoscopy of early stage endometrial and cervical cancer and borderline ovarian tumors can be performed with oncological safety and comparable prognosis to open surgery. Invasive ovarian cancer should be treated via open surgery. In cases of advanced stage gynecological malignancies laparoscopy provides a diagnostic tool facilitating the assessment of the para-aortic lymph node status before chemoradiation of cervical cancer and allows acquisition of tissue biopsies of ovarian cancer before neoadjuvant chemotherapy.     

Robotic surgery in gynecologic oncology

The goal of this paper is to review the current data documenting the advantages of robotic surgery over open or laparoscopic surgery. The aim of this study is to compare the complications and perioperative outcome of robotic surgery with open and laparocopic surgery, in gynecologic oncology. The terms radical robotic or robot- assisted hysterectomy in PubMed search lead to 41 references. We excluded one review of literature, ten studies with benign and malignant cases, eight cases reports, one letter to the editor. We kept the prospective studies and comparative studies (total abdominal hysterectomy (TAH) vs. total robotic hysterectomy (TRH), total laparoscopic hysterectomy (TLH) vs. TRH or TAH vs. TRH vs. TLH). The results are separated for endometrial cancers, early cervical cancers, pelvic and paraaortic lymph node dissections, radical parametrectomy and trachelectomy, and pelvic exenteration. The literature on robotic-assisted radical hysterectomy supports its safety and feasibility for the surgical management of early cervical cancer and endometrial cancer. However, the results of a phase III randomized clinical trial testing the equivalence of outcomes after laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy are expected.     

Brachial Plexus Injury after Laparoscopic and Robotic Surgery

The objective of this article was to review the literature regarding brachial plexus injury (BPI) in laparoscopic and robotic surgery. BPI complicates gynecologic laparoscopic surgery with an estimated incidence of 0.16%. Nevertheless, as the numbers of advanced laparoscopic and robotic procedures increase, the anticipated risk of this complication may rise as well. Robotic surgery often requires steeper Trendelenburg positioning and longer operative times when compared with traditional laparoscopic surgery. In this article we review the anatomy, pathophysiology, diagnosis, and treatment of position-related BPI in the context of laparoscopic and robotic gynecologic surgery. We suggest a multidisciplinary approach to the diagnosis and treatment of BPI. Recommendations for prevention of this complication are also provided.