机器人与腹腔镜全直肠系膜切除术的比较

Comparison of robotic and laparoscopic total mesorectal excision

腹腔镜全直肠系膜切除术（TME）目前已较普遍用于中低位直肠癌的手术治疗，但传统的腹腔镜系统因其2D视野及应用普通腔镜器械的局限性，导致腹腔镜TME手术难度大、学习曲线长。而机器人手术系统的3D视野及仿真手腕手术器械则可以克服传统腹腔镜的缺点，并有利于在深部狭窄的盆腔操作，灵活分离直肠远端周围间隙，进行TME。且机器人TME具有学习曲线短、手术中转率低等优点，没有腹腔镜手术经验的医生也可以直接开展。但根据已有的临床研究结果，目前尚无法肯定机器人TME手术优于腹腔镜TME手术。要肯定机器人手术的疗效，仍需要更多高级别的循证医学证据。目前，机器人手术系统临床推广应用存在的最大问题是费用过于昂贵；但最明显的好处是，外科医生操作机器人手术系统的舒适度高于腹腔镜手术操作，有利于进行长时间的复杂手术操作。可以肯定的是，机器人手术是科技发展的进步，是未来发展的方向。随着达芬奇手术系统专利保护期的结束，更多不同品牌的机器人手术系统问世，可能会大幅度降低手术费用而便于迅速推广。现在的青年医师学好腹腔镜TME，将来可迅速掌握机器人TME。

Laparoscopic total mesorectal excision （TME） has been commonly applied in the operation of mid-low rectal cancer, but the conventional laparoscopic TME has the disadvantages of major operative difficulty and long learning-curve, due to its limitations of 2-dimension vision and common laparoscopic instruments. Robotic surgical system with high-qualified 3-dimenstion vision and flexible Endo Wrist instruments can overcome those limitations of conventional laparoscopy, and is useful for the TME that demands deep pelvic operation and flexible dissection in the space of distal rectum. Robotic TME has the advantages of shorter learning curve and lower conversion rate, and it can even be performed by the surgeon with little laparoscopic experience. But according to the current studies, the superiority of robotic TME over laparoscopic TME can not be confirmed. To confirm the efficacy of robotic surgery, more high-level evidences are needed. Currently, the biggest obstacle for the widespread use of robotic surgical system is its high expense. But there is an obvious advantage that is the more comfortable feeling of surgeon while performing robotic surgical system, compared with performing laparoscopic operation, and it is helpful for long-time complicated operation. It is confirmative that robotic operation is the results of science and technology development, and it is the direction of future development. With the expiration of patent right of Da Vinci robotic system, there will be more kinds of robotic surgical systems which will lead to the much lower operation expense and the widespread use. The young surgeons should master the laparoscopic TME, which will help them master robotic TME technique quickly.