应用达芬奇机器人手术系统治疗低位直肠癌

Application of Da Vinci surgical system in the treatment of low rectal cancer

1994年经美国FDA批准，自动定位内镜系统作为机器人持镜手应用于普通外科临床，此后又开发了宙斯机器人系统，但FDA仅批准其作为外科手术助手而不能作为真正的手术者。达芬奇机器人手术系统是FDA批准的第1台真正应用于腹部外科的手术系统。自2001年开始，达芬奇机器人手术系统被应用于结直肠外科的微创治疗。我科于2009年6月成功完成了国内第1例低位直肠癌前切除术，效果良好。

The first few cases of colonic surgery using Da Vinci surgical system were reported in 2002 ; since then, Da Vinci surgical system has gradually been used in several centers for rectal cancer and with favorable outcomes. Laparoscopy has opened a new era in modem surgery, however, the inherent limitations of traditional laparoscopic surgery may cause certain difficulties during manipulation, especially in the demanding field of colonic laparoscopic surgery, which prolonged the learn- ing curve. The advantages of Da Vinci surgical system include stable camera platform, three-dimensional imaging, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. Low rectal region was regarded as the ＂forbidden zone＂ for laparoscopy, so we applied the Da Vinci surgical system in low anterior resection for rectal cancer. Because of multiquadrant operations in low anterior resection of rectal cancer, moving the robotic cart twice during the operation is necessary, which increased the operation time. In order to solve the problem, many surgeons use conventional laparoscopy for vessel ligation and flexure mobi- lization, and adopt the Da Vinci surgical system only in the lower quadrant of the abdomen. We present a technique that allows for the complete isolation of the mesorectum from the same position of the robotic cart, during the process, the enhanced dexterity and precise dissection offered by the Da Vinci surgical system were fully utilized.