胸外科应用达芬奇手术机器人的体会

目的介绍da Vinci S手术机器人系统不开胸手术的经验。方法本组17例患者包括重症肌无力12例（其中胸腺瘤3例）、膈疝1例、食管癌2例、肺大泡1例、肺癌1例。常规术前准备，取仰卧或侧卧位，双腔气管插管单肺通气静脉复合全麻。手术器械借着胸壁的孔洞连接到机器人的机械臂。外科医生坐于控制台前双手抓模拟抓手，它可将外科医生的动作转换传递到手术器械的尖端，进行切割、止血、缝合等外科操作。结果本组病例无死亡，无主要并发症。17例手术中，12例胸腺和胸腺瘤切除，1例膈疝修补，1例肺大泡切除；2例食管癌患者腹部用机器人行胃游离及腹部淋巴清扫加胸部小切口；1例左肺上叶切除术近结束时，由于出血，及时转为开胸手术。患者术后均恢复平稳。结论机器人在胸内进行手术时，对于不同手术，在体位、戳卡放置及器械械使用及手术方法上均有差别，术前术中都应妥善计划，认真施行。

The experiences with the da Vinci S robot in thoracic surgery

Objective To summarize the experiences with the da Vinci S operating robot for general thoracic surgery. Methods The study enrolled 17 patients with intrathoracic lesions, including 12 with myasthenia gravis, 1 with diaphragm hernia,2 with esophageal cancer, 1 with pulmonary cancer and 1 with pneumothorax. After routine preoperative preparation, the patients assumed a supine or lateral posi- tion. Compound venous anesthesia was induced by double - lumen endobronchial intubation for alternating one - lung ventilation. The surgical instruments were introduced into the chest cavity through the chest wall incision and connected to the operating robot. The simulators were taken by the surgeon who sits at the con- troller,and then the actions of the surgeon were passed to the surgical instrument tips. Manipulation such as cutting, stopping bleeding, sewing and so on was performed. Results The procedures were successfully completed in 14 patients who underwent thymectomy（ n = 12） ,diaphragm hernia repair（ n = 1 ）and pulmo- nary bleb dissection（ n = 1 ）. The procedures involving the abdominal part and small incision thoracotomy were done by using the da Vinci S system in 2 patients with esophageal cancer. Conversion to the open sur- gery occurred in a patient due to bleeding during resection of upper lobe of left lung. The postoperative courses were uneventful. Conclusion The indications for the da Vinci operating robot in thoracic surgery are large. The patient position, trocar position, instruments and methods vary with the different procedures. Surgical planning should be carefully made and undertaken before and during the operation.