Robot-Assisted Colon and Rectal Surgery-Experience of 110 Consecutive Cases in a Single Institute

機器手臂手術運用在大腸直腸外科－單一機構110病例的早期經驗

湯堯舜(Yiu-Shun Tong) ； 魏柏立(Po-Li Wei) ； 郭立人(Li-Jen Kuo)

《中華民國大腸直腸外科醫學會雜誌》 26卷2期 (2015/06) Pp. 64-70

https://doi.org/10.6312/SCRSTW.2015.26(2).10332

摘要

目的　機器手臂手術在大腸直腸外科上的使用是比較新的。這項研究提出了我們使用機器手臂大腸直腸手術的早期經驗和短期成果，並提供目前機器人的當前狀態。方法　自民國100年12月到民國103年6月，我們對110例接受機器手臂大腸直腸手術的患者進行回顧性的分析。臨床的資料，包括了病人的年齡，性別，臨床分期，手術時間，併發症和病理狀態進行分析研究。結果　有50名女性（45.5%）和60名男性（54.5%），年齡介乎30至89歲（平均50.9歲）。平均身體質量指數（BMI）為26.2kg/m2。66位病人（60.0%）接受了根除性直腸切除並大腸肛門吻合手術，23例（20.9%）接受了低位前切除手術，6例為（5.5%）為前切除手術，4例（3.6%）接受左半結腸切除手術，6例（5.5%）為右半結腸切除手術，3例（2.7%）有腹部會陰聯合切除手術，另2例（1.8%）接受Hartmann's手術。平均估計失血量為65.6毫升（範圍為30-200毫升）。平均手術時間為472.5分鐘（範圍305-725分鐘）。所有病人都沒有發生手術中從機器手臂手術轉換成傳統剖腹手術的案例。23名患者（20.9%）有術後併發症，包括腸壞死有6例，肛門狹窄4例，小腸阻塞3例，尿路感染3例，2例患者直腸尿道廔管和兩位病人發生帶狀皰疹感染。在本研究中，並沒有發生術中或30天的術後死亡率的報導。結論　我們提出我們運用機器手臂手術在大腸直腸外科的早期經驗。我們的數據顯示，機器人輔助大腸直腸癌手術是安全可行的，病人手術後併發症都在合理的範圍內，且病人都沒有因手術造成的三十日內死亡率。我們還需要進一步的前瞻性研究及累積更多的病人經驗，來驗證機器人輔助大腸直腸癌手術的優點。

關鍵字

大腸直腸癌 ； 達文西手術系統 ； 機器手臂手術

並列摘要

Purpose. The utilization of robotics in colorectal surgery is relatively new. This study presents our early experience and short-term outcomes with robotics in colorectal surgery and provides an update on the current status of robotics. Methods. Between December 2011 and June 2014, 110 patients undergoing robot-assisted colorectal surgery were analyzed retrospectively. Clinicopathologic results including patients' age, gender, clinical staging, operating time, complications, and pathologic status were analyzed. Results. The cohort comprised 50 women (45.5%) and 60 men (54.5%) with ages ranging from 30 to 89 years (mean, 50.9 years). The average body mass index (BMI) was 26.2 kg/m2. Sixty-six patients (60.0%) received radical proctectomy with coloanal anastomosis; 23 patients (20.9%), received low anterior resection; 6 (5.5%), for anterior resection; 4 (3.6%), for left hemicolectomy; 6 (5.5%), for right hemicolectomy; 3 patients (2.7%), had abdominoperineal resection; and 2 patients (1.8%), received Hartmann's procedure. Themean estimated blood loss was 65.6mL (range, 30-200 mL). The mean operating time was 472.5 minutes (range, 305-725 min). There was no conversion in any of the cases. Twenty-three patients (20.9%) had postoperative complications including coloanal anastomosis necrosis in 6 patients, anal stenosis in 4 patients, small bowel obstruction in 3 patients, urinary tract infection in 3 patients, rectourethral fistula in 2 patients, and herpes zoster in 2 patients. There was no intra-operative or 30-day post-operative mortality reported. Conclusion. We present our early experience of robot-assisted colorectal surgery. Our data show that robot-assisted colorectal surgery is feasible and safe, with acceptable rates of morbidity and mortality. Further prospective follow-up with a larger number of patients is needed to sophisticate and verify the advantages of robot-assisted colorectal surgery.

並列關鍵字

Colorectal cancer ； da Vinci surgical system ； Robotic surgery

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