机器人辅助与传统单孔腹腔镜手术在妇科领域的应用

随着腔镜技术不断发展和妇科医生腔镜手术技能的不断提高,妇科手术越来越微创化,使得以前必须开腹的手术而现在腹腔镜下就能达到同样的治疗效果,甚至由于腹腔镜的优势,该手术效果会更好.随着腹腔镜技术不断发展,腹腔镜手术变得越来越微创化,由传统的腹腔镜逐步发展到单孔腹腔镜(Laparoendoscopic single-site,LESS),再发展到经自然腔道腹腔镜手术(Natural orifice transumbilical endoscopic surgery,NOTES).妇科常用的手术是经阴道自然腔道腹腔镜手术(Transvaginal natural orifice transumbilical endoscopic surgery,vNOTES),医疗技术的每一次进步总是建立在良好的手术效果之上,需要妇科医生更高的手术技能.近年来,机器人技术已广泛应用于妇科腹腔镜手术,其优点包括:高清3D手术视野,机械臂及手腕更加灵活、稳定、精准,操作更舒适,可以进行远程手术.本文对妇科传统单孔腹腔镜手术(Laparoendoscopic single-site,LESS)和机器人辅助单孔腹腔镜手术(Robot-assisted laparoendoscopic single-site,R-LESS)的研究进行综述,从而为妇科医生在临床工作中选择合适的手术方式提供参考.     

单孔机器人或腹腔镜手术在膀胱疾病治疗中的应用现状

单孔机器人或腹腔镜手术已广泛应用于泌尿外科各类手术。现应用Medline查询并总结相关文献用于系统性回顾,概述并分析最新资料,以评价现有的单孔机器人或腹腔镜手术在膀胱疾病治疗中的应用及发展方向。分析表明单孔机器人或腹腔镜手术治疗膀胱疾病具有创伤小、术后恢复快等益处。手术器械的改进和机器人技术的应用,有望进一步明确单孔技术在微创泌尿外科手术中的作用及推广应用。     

机器人辅助单孔腹腔镜技术在泌尿外科的发展与展望

近年来,单孔腹腔镜技术一直是外科领域迫切需要但难以攻克的微创难点技术之一。机器人手术系统作为现阶段微创外科领域最先进的技术已广泛应用于临床,与此同时机器人辅助单孔腹腔镜技术也发生了巨大的飞跃。目前,机器人辅助单孔腹腔镜手术在临床的应用还处于快速成长阶段,其中也存在诸多的挑战。本文通过对国内外相关文献进行综合分析,介绍了机器人辅助单孔腹腔镜技术在泌尿外科领域的发展现状,并进一步展望机器人辅助单孔手术在泌尿外科的发展前景。     

达芬奇单孔机器人在外科手术中的应用及前景

随着微创技术的发展,无疤痕微创手术成为医生与患者的共同愿望。近年,达芬奇单孔机器人在妇科良性肿瘤、泌尿外科、结直肠外科取得的疗效已与传统腹腔镜、开腹手术相近。与传统机器人相比,单孔机器人的优势主要体现在：手术视野更清晰、机械更灵活与精准、远程操作平台更加人性化、微小切口更美观、更利于切口恢复等,深受青睐。本文将对目前达芬奇单孔机器人的临床进展作一综述。     

肾上腺肿瘤微创手术治疗方法的选择

肾上腺肿瘤是泌尿外科常见肿瘤之一,近年来随着微创手术技术的发展,腹腔镜手术逐渐成为肾上腺肿瘤微创治疗的金标准;同时单孔腹腔镜手术、机器人辅助腹腔镜手术在肾上腺肿瘤微创治疗领域被逐渐开展。本文对肾上腺微创治疗的现状及进展作一综述。     

悬吊式经脐单孔腹腔镜胆囊切除术的护理体会

<正>随着微创外科技术的发展,单孔腹腔镜手术已成为近期微创外科研究的热点,普通单孔腹腔镜手术因需充入CO2显露空间,存在漏气的缺点,且需持续灌注,其临床应用受套管系统密闭性、患者心肺功能及术后血栓形成等因素限制。悬吊式腹腔镜手术在保留了微创手术优点的同时,避免了人工气腹对机体的不利影响,扩大了手术适应证。2009年7月至今我院共为47例患者施行悬吊式经脐单孔腹腔镜手术,效果良好[1]。现将护理体会报道如下。1资料与方法     

单孔与传统三孔法腹腔镜手术治疗双侧精索静脉曲张的对比研究

目的:探讨单孔与传统三孔法腹腔镜手术治疗双侧精索静脉曲张的临床价值。方法:回顾分析2009年10月至2011年6月26例单孔腹腔镜和30例传统三孔法腹腔镜双侧精索静脉高位结扎术的临床资料。结果:两组术后住院时间、住院总费用、手术安全性、术后并发症等无明显差异,三孔组手术时间、操作难度优于单孔组,但单孔腹腔镜术后切口瘢痕小,更能体现微创、美容的效果。结论:单孔腹腔镜手术具有微创手术的所有优点,术后腹壁不留瘢痕,创伤更小,是微创治疗精索静脉曲张的新进展,值得推广应用,但手术时间较长,有一定的操作难度。     

机器人在肾部分切除术中的应用进展

肾癌是我国泌尿系常见的肿瘤之一。为了保留部分肾单位,对T1～T3期肾癌患者来说肾部分切除术为首选。肾部分切除术术式发展经历了从开放到普通腹腔镜,再到机器人辅助腹腔镜。机器人辅助肾部分切除术是一种有前景的微创手术,有经腹腔和后腹腔入路方式,各有优缺点,选择时可考虑不同途径手术的适应证。目前新技术,如吲哚菁绿(ICG)荧光实时显影技术、3D打印技术、虚拟现实技术等与机器人结合降低了手术难度,使复杂手术简单化。同时,机器人单孔肾部分切除术也逐渐应用于临床,其疗效和安全性也得到肯定。机器人具有操作灵活、高清3D画面及创伤小等优点,但高昂的费用限制了广泛应用,随着医疗水平与经济的发展,机器人手术必将成为微创的主流。     

单孔腹腔镜手术中肝脏牵拉方法的应用进展

<正>近年来,随着腹腔镜微创技术的发展,越来越多的腹部手术可以在单孔腹腔镜下完成。Piskun等~([1])1999年首次报道单切口腹腔镜手术,之后逐渐报道各种单孔腹腔镜手术~([2～6]),包括胃、胆道、胰腺、脾脏、肠道手术等,术后疼痛轻、快速康复的优点已被广泛认可。手术中视野的暴露对成功施行单孔腹腔     

郑氏4C悬吊法在经脐单孔腹腔镜妇科恶性肿瘤手术中的应用

经脐单孔腹腔镜技术(transumbilical laparoendoscopic single-site surgery,TU-LSSS)因有微创、美观、术后恢复快、取标本快速安全等优点,近年来在妇科微创手术领域的优势地位日益凸显,已成为传统多孔腹腔镜手术的有益补充,广泛应用于妇科良性疾病。但是,由于单孔腹腔镜手术自身的局限性和操作技术难度较高,缺少助手帮助、手术视野显露相对困难等,在一定程度上限制了单孔腹腔镜技术在操作较为复杂的妇科恶性肿瘤手术中的推广应用。     

机器人手术系统在卵巢癌治疗中的应用进展

卵巢癌是一种威胁女性健康的恶性肿瘤,恶性程度高,病死率居妇科肿瘤之首,手术是其主要的治疗方式。随着科技的进步,研究者在腹腔镜手术原理的基础上,开发了更加精准的达芬奇机器人手术系统,其具有微创、精细、灵活、滤抖等诸多优点,并引领着妇科手术迈向精准医疗的新征程。作为一种新兴的手术方式,机器人手术在卵巢癌的治疗与应用中存在诸多争议。本研究主要针对卵巢癌治疗的现状与争议进行深入剖析,对比分析机器人、腹腔镜及开腹手术治疗卵巢癌的手术疗效,并对机器人手术的发展及应用进行展望。     

Updates in robotic colorectal surgery

Since the introduction of master-slave manipulators (otherwise known as telemanipulators) in 1990, minimally invasive surgery paved the way for the development of the first robotic surgical systems to overcome the limitations of laparoscopic surgery. The robotic system over the last decade has rapidly gained acceptance and popularity among surgeons, especially colorectal surgeons around the world. Advantages of robotic surgical systems includes superior instrumentation and stable field of vision which enable precise dissection in confined spaces such as the pelvis. The feasibility and safety of robotic rectal surgery is now well established and there is increasing evidence that it might offer superior perioperative and postoperative outcomes when compared to laparoscopic rectal surgery. Robotic rectal surgery is easier to learn than laparoscopic surgery and the creation of a structured training program for robotic rectal surgery in Europe and USA has facilitated the learning of this technique in an environment that promotes patient safety and improved patient outcomes through equipment fidelity and operator skills. It is foreseeable that in the near future robotic systems will become part of routine surgical practice in colorectal surgery.     

Updates in robotic colorectal surgery

Since the introduction of master-slave manipulators (otherwise known as telemanipulators) in 1990, minimally invasive surgery paved way for the development of the first robotic surgical systems to overcome the limitations of laparoscopic surgery. Over the last decade, the robotic system has rapidly gained acceptance and popularity among surgeons, especially colorectal surgeons around the world. Advantages of robotic surgical systems includes superior instrumentation and stable field of vision which enable precise dissection in confined spaces such as the pelvis. The feasibility and safety of robotic rectal surgery is now well established and there is increasing evidence that it might offer superior perioperative and postoperative outcomes when compared to laparoscopic rectal surgery. Robotic rectal surgery is easier to learn than laparoscopic surgery and the creation of a structured training program for robotic rectal surgery in Europe and USA has facilitated the learning of this technique in an environment that promotes patient safety and improved patient outcomes through equipment fidelity and operator skills. It is foreseeable that in the near future robotic systems will become part of routine surgical practice in colorectal surgery.     

机器人微创心脏手术的应用现状

微创是心脏外科的发展方向之一.随着自动机械和计算机技术的进步,机器人微创外科手术已成为现实.机器人微创心脏手术具有创伤小、操作精细等优点,是微创心脏外科的前沿技术之一.作为一种革新的手术方式,机器人辅助下微创心脏手术得到了极大的关注,本文就机器人心脏手术的临床应用及手术效果作一综述.     

腔镜和机器人手术在乳腺癌外科应用进展

近年来,以腔镜技术和机器人手术系统为代表的微创外科技术日趋成熟。鉴于其精准、微创、美观等优势,在乳腺外科领域得到了广泛应用,也形成了相对完善的技术体系。目前,在合理的适应证下,传统乳腺癌外科手术均可在腔镜和机器人辅助下完成,同时腔镜技术和机器人手术系统在乳房重建领域也体现出独特优势。伴随着国内外各医疗机构的广泛开展和技术突破,乳腺微创外科展现出更广阔的前景。     

LESSons in minimally invasive urology

Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. LaparoEndoscopic Single Site (LESS) surgery potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. Technological developments in instrumentation, access and optics devices are overcoming some of the challenges that are raised when operating through a single site. Further advances in the technique have included the incorporation of robotics (R-LESS), which exploit the ergonomic benefits of ex vivo robotic platforms in an attempt to further improve the implementation of LESS procedures. In the future, urologists may be able to benefit from in vivo micro-robots that will allow the manipulation of tissue from internal repositionable platforms. The use of magnetic anchoring and guidance systems (MAGS) might allow the external manoeuvring of intra-corporeal instruments to reduce clashing and facilitate triangulation. However, the final promise in minimally invasive surgery is natural orifice transluminal endoscopic surgery (NOTES), with its scarless technique. It remains to be seen whether NOTES, LESS, or any of these future developments will prove their clinical utility over standard laparoscopic methods.     

How I Do It: Hybrid Laparoscopic and Robotic Pancreaticoduodenectomy

Minimally invasive pancreatic resections remain technically challenging. Distal pancreatectomy has been embraced at multiple centers as an acceptable minimally invasive technique in selected patients. In contrast, minimally invasive pancreaticoduodenectomy has not achieved broad acceptance, partly due to technical challenges. We detail a minimally invasive technique that utilizes both laparoscopic and robotic approaches which capitalizes on the advantages of each. Our early results have encouraged the continued development of this minimally invasive pancreatic surgery program. This hybrid technique may be an approach that is useful for surgeons striving to adopt the advantages of minimally invasive surgery for their patients.     

达芬奇机器人胃癌根治术的现状与发展

作为微创手术领域的前沿技术,达芬奇机器人手术系统受到越来越多的关注。与传统腹腔镜手术相比,达芬奇机器人胃癌根治术具有术中出血少、术后并发症发生率低等优势,但也存在手术时间长、费用昂贵等不足。随着手术机器人缺陷的改进、新型手术机器人的研制以及通信技术的发展,机器人手术系统在胃癌外科领域有广阔的应用前景。     

理念革新:微创外科新视角

腹腔镜视觉平台的发展与革新,推动了整个外科从开腹手术到微创手术的理念革新与技术变革。从最初利用烛光反射镜装置窥视人体内部的内镜雏形,到高清、超高清腹腔镜视觉系统,从腹腔镜胆囊切除术,到腹腔镜下包括肿瘤根治手术在内的各类普通外科手术的普及与推广,外科手术因微创技术而发生巨大变革。进入新时代,3D、4K腹腔镜的应用,再次给微创外科带来新视角,从而推动手术朝着精准解剖和功能保护方向发展。未来,新型冠状病毒后疫情时代带来的理念革新,有可能使第5代移动通信技术加持下的虚拟现实技术和机器人手术,及在此基础上的远程医疗与远程教学成为微创外科发展的新视角。     

Feasibility and preliminary clinical outcomes of robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-port platform

This study tested the technical feasibility and short-term perioperative outcomes of the novel da Vinci Single-Site Instrumentation platform for the treatment of upper ureteropelvic junction obstruction (UPJO) in a selected group of patients. Nine patients underwent robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-site platform for UPJO at our department of urology. All the procedures were completed without the need for traditional robotic surgery or laparoscopic/open conversion, although in one patient with congenital hepatomegaly it was necessary to use an auxiliary 3-mm trocar to retract the liver properly and expose the surgical field. Mean operative time was 166 min, and no intraoperative complications were recorded. The indwelling catheter was removed on postoperative day 2 in five patients and on postoperative day 3 in four patients. Patients were discharged the day after drain removal. One patient experienced transient hyperpyrexia, treated with antibiotics. No other complications were observed. All patients had the DJ stent removed 4 wk after surgery, following a negative urine culture and abdominal ultrasound evaluation. The five patients who reached a 3-mo follow-up had a clinical resolution of preoperative symptoms and hydronephrosis at the abdominal ultrasound. The same results were maintained in the two patients with 6-mo follow-up evaluations. In selected patients, R-LESS pyeloplasty using the new single-port platform appears to be a technically feasible and reproducible surgical procedure for the minimally invasive treatment of UPJO. Prolonged follow-up and larger series are required to confirm its potential role as a valid alternative to standard robotic pyeloplasty.