机器人辅助腹腔镜前列腺癌根治术的手术配合

目的探讨机器人辅助腹腔镜前列腺癌根治术的护理配合,提高护士的手术配合质量。方法对国内首次开展的16例机器人辅助腹腔镜前列腺癌根治手术配合进行总结分析。结果16例机器人辅助腹腔镜前列腺根治术顺利完成,无一例中转开腹。结论充分的术前准备和熟练的手术配合是机器人手术成功的重要因素。     

Robotic fundoplication in children

Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci Surgical System from Intuitive Surgical, were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.     

探讨腹部外科微创手术治疗的升级

腹部外科手术涉及部位解剖复杂,血管丰富,术中病人变异较大,手术难度大,一直是微创外科的难点.科技创新的发展,手术机器人系统的应用,很好地助力了腹部外科再上微创新台阶,腹腔镜微创手术治疗也得到了进一步升级.由于手术机器人系统具有三维手术视野,能自动消除生理颤动,手术器械手臂能自由灵活旋转达到传统机器无法完成的部位和角度,...     

腹直肌直线套管法单机位机器人辅助腹腔镜肾输尿管切除术的疗效分析

单机位机器人辅助腹腔镜肾输尿管切除术处理输尿管远端和膀胱时难度较大。我院对32例输尿管癌患者行腹直肌直线套管法单机位机器人辅助腹腔镜下肾输尿管切除术,手术难度低,手术时间短,出血量少,手术损伤小。该手术方式是治疗输尿管癌的一种安全有效的微创手术方法。     

腔镜甲状腺手术的演变和发展

人工和机器人腔镜甲状腺手术的不断发展,有效地减少了甲状腺手术并发症及颈部瘢痕的形成,得到了广大外科医师及患者的认可。但是,人工和机器人腔镜甲状腺手术发展至今,其衍生的术式及入路种类繁多,不同的术式及入路具备各自的优劣势。在适应证范围内,人工和机器人腔镜甲状腺手术与传统甲状腺手术的效果相当,应用前景更加广阔。     

隐蔽切口法在机器人辅助腹腔镜下儿童肾肿瘤根治术标本取出中的应用体会

目的 初步探讨隐蔽切口法(Hidden Incision)在机器人辅助腹腔镜下儿童肾肿瘤根治术(Robot-assisted laparoscopic radical nephrectomy,RAL-RN)标本取出中应用的价值。方法 回顾性分析2015年8月至2019年2月收治的6例机器人辅助腹腔镜下肾肿瘤根治性切除患儿的临床资料。其中男4例,女2例;平均年龄3岁11个月;肾母细胞瘤3例,Xp11.2易位/TFE3基因融合相关肾癌2例,后肾腺瘤1例;肿瘤位于左肾3例,右肾3例。术中均采取健侧60°卧位,目镜Trocar位于脐缘(病灶对侧缘),操作孔1位于前正中线脐上6~7 cm(具体取决于患儿腹壁空间),操作孔2进皮点位于前正中线与下腹部腹横纹交点,进腹腔点在进皮点上方约1.5 cm处(Trocar于皮下潜行)。如需辅助孔,则辅助孔Trocar置于患侧下腹部腹横纹延长线上。所有患儿均实施根治性切除术,标本切除后完整置入标本袋,延长下腹部切口(切口长度大于等于瘤肾最小径),标本袋经下腹部腹横纹切口完整取出。结果 6例患儿中,采用辅助孔3例,未采用辅助孔3例。切口长度5~8 cm,平均6.5 cm。所有标本均经下腹部腹横纹切口通道完整取出,无一例术中中转开放。术后住院4~7 d,平均4.5 d。术后伤口无活动性出血、裂开、感染等情况发生。术后随访4~46个月,平均25个月。术后伤口恢复可,未见明显瘢痕增生。结论 隐蔽切口法可安全、有效地应用于儿童RAL-RN术中标本的取出。     

An embodied biologically constrained model of foraging: from classical and operant conditioning to adaptive real-world behavior in DAC-X

Animals successfully forage within new environments by learning, simulating and adapting to their surroundings. The functions behind such goal-oriented behavior can be decomposed into 5 top-level objectives: ‘how’, ‘why’, ‘what’, ‘where’, ‘when’ (H4W). The paradigms of classical and operant conditioning describe some of the behavioral aspects found in foraging. However, it remains unclear how the organization of their underlying neural principles account for these complex behaviors. We address this problem from the perspective of the Distributed Adaptive Control theory of mind and brain (DAC) that interprets these two paradigms as expressing properties of core functional subsystems of a layered architecture. In particular, we propose DAC-X, a novel cognitive architecture that unifies the theoretical principles of DAC with biologically constrained computational models of several areas of the mammalian brain. DAC-X supports complex foraging strategies through the progressive acquisition, retention and expression of task-dependent information and associated shaping of action, from exploration to goal-oriented deliberation. We benchmark DAC-X using a robot-based hoarding task including the main perceptual and cognitive aspects of animal foraging. We show that efficient goal-oriented behavior results from the interaction of parallel learning mechanisms accounting for motor adaptation, spatial encoding and decision-making. Together, our results suggest that the H4W problem can be solved by DAC-X building on the insights from the study of classical and operant conditioning. Finally, we discuss the advantages and limitations of the proposed biologically constrained and embodied approach towards the study of cognition and the relation of DAC-X to other cognitive architectures.     

Comparative analysis of early perioperative outcomes following radical cystectomy by either the robotic or open method.

OBJECTIVE: We analyzed early perioperative outcomes following radical cystectomy by the robotic method compared with the conventional open method. METHODS: All relevant clinical information was entered in a Microsoft Access Database and queried. P < 0.05 were considered statistically significant. RESULTS: The study cohort comprised 37 consecutive patients undergoing radical cystectomy; 24 (64.9%) cases were performed by the conventional open method and 13 (29.7%) by the robotic method. Body mass index, age, sex, blood transfusion rate, and median decrease in hemoglobin were comparable between the 2 groups. The robotic method resulted in significantly lower median estimated blood loss, shorter hospital stay, and longer operating time compared with the open group (P < 0.05). Four (16.7%) perioperative complications occurred in the open group compared with 2 (15.4%) in the robotic group (P = 1.0). The incidence of organ-confined (< or =T2N0Mx) disease was 9 (37.5%) and 7 (53.8%) in the open and robotic groups, respectively (P = 0.49). CONCLUSIONS: Radical cystectomy by the robotic method produces early perioperative results comparable to those of the open method. Although intraoperative estimated blood loss and hospital stay were significantly lower in the robotic group, operative time was longer which likely reflects our early operative experience with radical cystectomy by the robotic method.     

机器人直视下切除低位直肠癌下切缘行保肛手术

目的低位直肠癌机器人腹腔内直视下切断下切缘行全直肠系膜切除术,探索该术式的疗效及优势。方法回顾2020年5~12月江苏省中医院采用机器人腹腔内直视下低位直肠癌根治术保肛治疗3例患者的临床资料,平均年龄65.7岁。术前患者全部确诊为直肠癌,肿瘤下缘距肛缘2.0~3.5 cm,均未累及肛管。结果3例手术均顺利完成,术中未中转开腹及增加操作通道。手术时间平均约290 min,术中出血量平均约80 ml。术后2 h,患者麻醉清醒后即可进少量流食。均在术后1 d拔除导尿管,自行排尿顺畅,无尿潴留表现。术后肛门排气时间平均约1.8 d,术后住院时间平均4.8 d。标本下切缘及中低位直肠癌环周切缘均为阴性,下切缘距肿瘤距离平均1.8 cm。术后3个月肛门指检及肠镜检查吻合口愈合良好。所有患者按计划均顺利完成造口还纳。术后患者肛门控便功能良好,无术后局部吻合口周围感染、吻合口出血、吻合口瘘及狭窄等并发症。结论低位直肠癌根治行保肛手术,在机器人腹腔内直视下切断下切缘技术行之有效,是低位直肠癌根治保肛手术的一种有益尝试,临床结果良好,值得进一步研究应用。