达芬奇-S外科手术辅助系统在普胸外科的应用

Application of da Vinci-S Surgical System to general thoracic surgery

目的评价使用达芬奇-S外科手术辅助系统(机器人)行不开胸普胸手术,观察其实用性及手术效果。方法利用达芬奇-S外科手术辅助系统对46例患者行普胸手术,其中胸腺切除术18例、食管癌根治术4例、双侧广泛肺大泡切除缝扎术1例、肺叶切除术18例、肺楔形切除术4例、食道-左主支气管瘘修补术1例。结果 46例患者的手术均为全机器人完成,无中转开胸手术,患者术后均恢复平稳,平均住院时间为4.6 d(2～9 d)。结论几乎所有类型的胸科手术辅助系统都可以做到不开胸,手术安全可靠,效果确实,与传统开胸手术方式相比优势明显,损伤小、恢复快。但要注意医师及其他操作人员需具备胸科开放性手术经验,注意患者的选择,并做好紧急开胸的准备,以保证患者的安全。

Objective The purpose of this study was to evaluate the effect and practicability of robotic-assisted general thoracic surgery.Methods From June 2010 to February 2010,we performed robotic-assisted thoracic surgery on 46 patients,including 18 cases of thymusectomy,4 cases of esophagectomy,18 cases of lobectomy,4 cases of wedge resection of lung,1 case of bilateral lung bulla resection and transfixion,and 1 case of esophageal-left principal tracheal fistula repair.Results Totally robotic thoracoscopic surgery was performed for all the cases with the da Vinci S Robotic Surgical System(Intuitive Surgical,Inc,Sunnyvale,CA).No conversions,intraoperative complications or deaths occurred.All the patients recovered smoothly,with a mean hospital stay of 4.5 days,ranging from 2 to 9 days.Conclusion Robotic-assisted surgery,obviously advantageous over open-chest surgery for its minimal invasiveness and faster recovery,can be performed safely and efficiently in almost all general thoracic operations.However,proper selection of patients,rich experience and adequate preparation for open-chest surgery on the part of the surgeon are very important to ensure the safety of the patient.