腹腔鏡手術及機械手臂手術之優點及其限制

The Advantages and Limitations of Laparoscopic and Robotic Surgery

陳國鋅(Kuo-Hsin Chen)

《台灣醫學》 21卷2期 (2017/03) Pp. 173-177

https://doi.org/10.6320/FJM.2017.21(2).6

摘要

腹腔鏡微創手術為近三十年來，外科手術的重要發展。手術傷口因使用微創器械及腹腔鏡影像系統而大幅縮小，術後疼痛大幅改善。手術視野因影像放大而更加清晰，有利於外科醫師進行更準確之手術。多項研究皆顯示微創手術術後恢復較傳統剖腹手術快，術後傷口併發症較少，如傷口感染及切口疝氣等。手術中出血較少，但手術時間也許較長。機械手臂手術在某些部份可能克服傳統腹腔鏡的缺點。如3D立體影像，方便精細手術進行，手術器械具有近手腕動作，提昇器械靈巧性，機械手臂手術電腦可去除術者手臂生理性抖動，提昇準確性。但機械手臂手術系統造價昂貴，維修及耗材所費不貲。操作機械手臂需外科醫師另外的學習，相關手術室團隊，麻醉團隊的配合也須仔細研究。手術器械完全沒有觸覺回饋，力道不易掌握，必須小心進行。機械手臂手術雖具若干優勢，可縮短外科醫師完成複雜微創手術的學習期，惟臨床效益，仍待長期追踪以驗證成效。

關鍵字

腹腔鏡手術 ； 機械手臂手術 ； 微創手術 ； 優點及限制

並列摘要

Minimally invasive surgery has reshaped the modern surgery in the past 3 decades. Potential advantages include enhanced patient recovery, less wound pain, less wound complications and better cosmetics. However, traditional laparoscopic surgery has been associated with some limitation, like 2-Dimentional image, less tactile feedback, limited choices in surgical instrument and poor surgeon's ergonomics. Robotic surgical system had been developed to overcome the drawbacks of traditional laparoscopic approach, however, it has own limitations such as lack of tactile feedback, higher cost, longer operation time, steep learning curve and even more limited choices in instruments. Robotic approach has been considered advantageous to perform fine dissection in narrow space. To improve surgical outcome, to take the advantages and avoid the limitation are the main missions of contemporary surgical revolution.

並列關鍵字

laparoscopic surgery ； robotic assisted surgery ； minimally invasive surgery

參考文獻

Ciria R, Cherqui D, Geller DA, et al: Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 2016;263:761-77."

Capogrosso P, Salonia A, Briganti A, et al: Postprostatectomy erectile dysfunction: A review. World J Mens Health 2016;34:73-88."

Wakabayashi G, Cherqui D, Geller DA, et al: Laparoscopic hepatectomy is theoretically better than open hepatectomy: Preparing for the 2nd international consensus conference on laparoscopic liver resection. J Hepatobiliary Pancreat Sci 2014;21:723-31."

Chen KH, Huang CC, Siow TF, et al: Totally laparoscopic living donor right hepatectomy in a donor with trifurcation of bile duct. Asian J Surg 2016;39:51-5."

Giulianotti PC, Bianco FM, Daskalaki D, et al: Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg Nutr 2016;5:311-21."