Robotic-Assisted Laparoscopic Rectal Surgery: A Tertiary Center Experience

目的　機械手臂的好處在於多關節的器械及較立體視覺，在處理狹窄骨盆腔的直腸手術中被認為是可以克服某些腹腔鏡手術本身的限制。這是一篇來自於醫學中心的機械手臂輔助腹腔鏡直腸切除手術的經驗報告。方法　從2012年2月至2013年7月，在單一醫院所有接受機械手臂輔助腹腔鏡直腸切除手術的病患，回溯性分析病患基本資料，手術中資料，術後併發症，住院天數及病理組織學報告。結果　全部共16位病患，接受機械手臂輔助腹腔鏡直腸切除手術，其中11位男性、5位女性。3位接受低前位切除手術，12位接受肛門保留全直腸繫膜切除手術，1位接受經腹會陰直腸切除手術。15位病患診斷為直腸線癌，1位病患診斷為低位直腸腸胃道基質瘤。平均手術時間為354分鐘，術後平均住院天數為8.2天。全部病患皆未在術中轉換成傳統剖腹方式手術。1位病患術後發生腹腔鏡套管穿刺孔傷口感染，2位病患發生了腸吻合處滲漏，3位病患臨床上出現術後腸麻痺並接受了鼻胃管置放來減壓，另有2位病患在尿管移除後因為尿滯留而再次接受了留置導尿。無患者因手術死亡。病理組織學部分，平均取下的淋巴結數目為15.5顆，遠端距離腫瘤平均為2.81公分。結論　機械手臂輔助腹腔鏡直腸切除是安全及可行的方式。然需要更多的研究才能知道其是否優於傳統腹腔鏡直腸切除手術。

關鍵字

機械手臂；腹腔鏡直腸切除；直腸惡性腫瘤；低前位切除手術；全直腸繫膜切除手術

並列摘要

Purpose. The advantages of robotic-assisted surgery are the usage of multiarticulated instruments with superior dexterity and 3-dimensional visualization; it is thought to help overcome the limitations of laparoscopic rectal surgery in the narrow pelvis. This is a single center experience report of robotic-assisted laparoscopic surgery. Methods. Between February 2012 and July 2013, all the patients who underwent robotic-assisted colorectal surgery were retrospectively evaluated in terms of demographics, surgical data, complications, duration of hospital stay, and histopathological data. Result. Sixteen consecutive patients, 5 female and 11 male patients, underwent robotic-assisted laparoscopic rectal resection. Low anterior resection was performed in 3 patients. Sphincter-saving total mesorectal excision (TME) was performed in 12 patients and abdominoperineal resection (APR), in 1 patient. Of the 16 patients, 15 had adenocarcinoma, and 1, gastrointestinal stromal tumor. With regard to surgical technique, all the surgeries performed were hybrid robotic-assisted laparoscopic rectal operations. The average duration of surgery was 354 min. The average duration of postoperative hospital was 8.2 days. No operation was converted. One patient experienced port site infection, 2 experienced anastomotic leakage, 3 underwent nasal tube intubation for post-operation ileus, and 2 underwent urinary catheter reinsertion after removal. There was no mortality in our series. The median number of harvested lymph nodes was 15.5, and the distal resection margin was 2.81 cm. Conclusion. Robotic-assisted rectal surgery was found to be a safe and feasible procedure. However, more evidence is needed regarding whether it is superior to convention laparoscopic colorectal surgery.

並列關鍵字

Robotic-assisted ； Laparoscopic rectal surgery ； Rectal cancer ； rectal surgery ； Low anterior resection ； Total mesorectal excision

參考文獻

1. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM et al Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359(9325):2224–9

2. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH et al Short-term endpoints of conventional versus laparoscopicassisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365(9472):1718–26

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國際替代計量

Robotic-Assisted Laparoscopic Rectal Surgery: A Tertiary Center Experience

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