达芬奇机器人Xi系统在肝切除术中的应用

目的 总结本中心应用达芬奇机器人Xi系统在肝切除中的效果和布孔和程序化操作方面的经验。方法 回顾性分析苏州大学附属第一医院肝胆胰外科2020年10月至2022年5月期间施行达芬奇机器人肝切除手术的38例患者的临床和病理资料。结果 38例均采用达芬奇Xi系统成功完成肝切除手术，1例因手术创面止血不满意中转开腹。术中采用反L型布孔加快装机步骤，减少频繁更换器械的困扰，适用于大部分肝切除术。右半肝切除中超声刀优先置于4号臂进行肝门处理，随后切换至2号臂左手操作断肝，可以保证良好的切肝角度，联合两侧机械臂的配合，形成类似于“三叉戟”的切除模式。布置1～2个助手孔，利用吸引器及电凝设备保持术野清晰。术后病理：肝脏恶性肿瘤29例（均为R0切除），良性肿瘤5例，肝内外胆管结石3例，肝脓肿1例。中位手术时间250（126）min，术中出血量100（110）mL，手术并发症发生率为7.9%（3/38），均经保守治疗治愈，无围手术期死亡。34例患者术后留置引流管，置管时间4（1）d，术后住院时间6（2）d。结论 机器人辅助肝切除术安全可行，机器人平台的信息整合以及灵活操作的独有特点，有助于精准解剖性肝切除开展和进一步减少肝切除手术的创伤。程序化手术布局及手术流程，有利于缩短机器人肝切除术的学习曲线。

Application of da Vinci Xi robotic system in hepatectomy

Objective To summarize experience in application, shaped port position and operative procedure of da Vinci Xi robotic system in hepatectomy. Methods The clinical and pathological data of 38 patients receiving robotic hepatectomy between Oct. 2020 and May 2022 in the First Affiliated Hospital of Soochow University were analyzed retrospectively. Results Thirty-eight patients received hepatectomies by da Vinci Xi robotic system. Only 1 patient accepted open conversion surgery for unsatisfactory hemostasis. In operation, the use of reverse L-shaped port position accelerated the installation process, and avoided frequent instrument replacement, which was suitable for most hepatectomy. In right hemihepatectomy, the ultrasonic knife was placed on the fourth arm preferentially, to dissect the porta hepatis, then switched to the second arm to cut the liver with left hand, which ensured suitable liver resection angle, combined with the cooperation of both mechanical arms, formed a resection mode similar to “Trident”. With suction and electrocoagulation devices through one or two assistant holes, to maintain a clear surgical field. The postoperative pathology showed 29 cases of malignant tumor with R0 resection, 5 cases of focal nodular hyperplasia of the liver, 3 cases of intra-and extrahepatic bile duct stone, and 1 case of liver abscess. The median operation time was 250(126) minutes, the intraoperative bleeding was 100(110) mL. Postoperative complication rate was 7.9%(3/38), all patients were cured by conservative treatment. Thirty-four patients kept abdominal drainage tube for 4(1) d. The postoperative hospitalization time was 6(2)d.Conclusion Application of da Vinci robotic system in hepatectomy is safe and feasible. The information integration and operation flexibility of robotic platform facilitate the development of precise anatomical hepatic resection, and further reduce the trauma caused by traditional hepatectomy. Programmed surgical layout and procedures are beneficial for shortening the learning curve of robotic hepatectomy.