达芬奇手术机器人系统在疝外科的应用

Application of Da Vinci robotic surgery to hernia repair

达芬奇（Da Vinci）手术机器人系统给微创外科带来巨大变革，对于疝外科的推动作用更是不容小觑，目前已被成功用于腹壁切口疝、食管裂孔疝及腹股沟疝的修补手术。在腹壁切口疝修补方面，Da Vinci手术机器人系统高达7个自由度的机器腕、高清的术野和裸眼3D成像，使其能轻易在腹腔内完成精细的前腹壁缝合，无论是经腹腔的腹膜前修补（TAPP）、腹腔内修补（IPOM）还是后成分分离技术（pCST）都能轻松完成。在食管裂孔疝修补方面，Da Vinci手术机器人系统的超清术野和机器腕也使神经及动脉的辨识更为准确，局部缝合更为容易,补片放置和固定更为可靠。然而，在腹股沟疝修补方面，传统2D腹腔镜技术目前已能给患者提供足够的微创优势，Da Vinci机器人手术系统的费用较高，在该方面的优势并不明显。小样本及回顾性的研究表明，Da Vinci手术机器人系统在各类疝修补手术中的应用安全、有效，但尚缺乏大宗的前瞻性随机对照研究来评价其近期和远期效果。随着Da Vinci手术病例的积累、医生手术技巧的提高及各种临床试验的开展，相信Da Vinci手术机器人系统将在疝外科领域大放异彩。

Da Vinci robotic surgical system has brought giant evolution to minimally invasive surgery, and also improved the development of hernia surgery. Recently, Da Vinci robotic surgical system has been successfully applied to the repair of incisional hernia, inguinal hernia, and esophageal hiatal hernia. In the area of incisional herniorrhaphy, endowrist with 7 degrees of freedom, high definition and naked eye 3D imaging system can make Da Vinci robotic surgical system easy to complete the subtle suture in the anterior abdominal wall from the abdominal cavity. As a result, transabdominal preperitoneal repair （TAPP）, intraperitoneal onlay mesh （IPOM） or the posterior components separation techniques （pCST） can be easily accomplished. In the repair of esophageal hiatus hernia, the high definition field and flexible machine wrist of the Da Vinci robotic surgical system also make the identification of nerve and artery more accurate, and the local suture more easy, and the prosthetic placement and fixation more reliable. However, in the field of inguinal hernia repair, the traditional 2D laparoscopic technology is able to provide patients with sufficient minimally invasive advantages, and Da Vinci robotic surgical system does not have obvious advantage because of its expensive cost. Previous small-sample and retrospective studies showed that Da Vinci robotic hernia repair was safe and effective, and had more fineness and dexterity than conventional laparoscopic hernia repair. However, large-sample prospective randomized control trials are still absent for short- and long-term evaluation of Da Vinci robotic hernia repair. With the accumulation of robotic hernia repair cases, the increase of surgical experience, and the development of clinical trials, Da Vinci robotic surgical system will play more important role in hernia repair.