达芬奇机器人手术系统在精准肝切除中的应用

目的 探讨达芬奇机器人手术系统在精准肝切除中应用的可行性、安全性及优势.方法 回顾性分析2009年4月至7月解放军总医院应用达芬奇机器人手术系统对13例肝病患者行精准肝切除的临床资料进行.结果 所有患者手术获成功,无中转开腹.其中广泛肝切除9例,左外叶切除4例.所有患者鞘内解剖选择性人肝血流阻断下的解剖性肝切除.平均手术时间为338 min(150～720 min),平均失血量为208 ml(50～800 ml),无术中、术后输血.术后仅1例患者出现胆汁漏,经保守治疗后痊愈,无围手术期死亡.术后平均住院时间为7 d(2～13 d).结论 达芬奇机器人手术系统行精准肝切除安全可行,它极大地拓展了腹腔镜肝切除的适应证,尤其利于精准的肝门解剖和腹腔镜下缝合.

Da Vinci surgical system-assisted precise hepatectomy

Objective To assess the feasibility,safety and advantages of robotic-assisted precise hepatectomy.Methods Between April and July 2009,13 consecutive patients underwent robotic-assisted hepatectomy for hepatic diseases.The clinical data were analyzed retrospectively.Results All 13 Da Vinci surgical systemassisted precise hepatectomies were successfully performed without conversion to laparotomy.Major hepatectomies were performed in 9 patients,left lateral segmentectomies in 4 patients.All the Da Vinci surgical system-assisted hepatectomies were performed anatomically with hilum dissection.Prior to the parenchymal transaction,vascular control of the portal vessels was carried out whenever possible.The mean operative time was 338 minutes(range,150-720 minutes).The mean blood loss was 208 ml(range,50-800 ml).No patient required blood transfusion,and no mortality,transient bile leakage was observed in patients with hilar cholangiocarcinoma.The mean postoperative stay was 7 days(range,2-13 days).Conclusions These preliminary results show that Da Vinci surgical system-assisted precise hepatectomy is safe and feasible with potential benefits of a minimally invasive approach.Da Vinci surgical system may broaden the indications for laparoscopic hepatactomy,and it enables surgeons to perform precise laparoscopic hepatectomy which required hilum dissection,hepatocaval dissection,endoscopic suturing and microanastamosis.