浅谈微创手术在妇科恶性肿瘤领域的现状

A brief discussion on the status of minimally invasive surgery in gynecologic malignant tumor

微创手术是外科领域近30年来最伟大的技术革新。与传统开放手术相比,它大大减少了手术创伤和切口相关并发症,如手术部位感染、术后疼痛、疝等,微创手术也缩短了在院时间,保持了腹壁皮肤的完整性。尽管如此,微创手术技术仍在进一步更新,因为传统腹腔镜手术存在深度感知受限、摄像机稳定性欠缺、运动范围有限、学习曲线陡峭等局限性。因此,20世纪80年代以来,为克服传统腹腔镜技术所遇到的瓶颈,在复杂手术中提高手术的准度和精度,促进微创手术的革新和广泛应用,机器人手术系统应运而生,它改进了三维立体视觉、扩大了术者视野、提高了操作设备的灵巧性、降低了可能影响手术精度的震颤。目前,机器人手术系统作为一个前沿的微创手术方法已广泛应用于妇科领域,尤其是妇科恶性肿瘤领域。笔者通过回顾文献,并结合自己的经验,总结达芬奇机器人系统在妇科恶性肿瘤领域的应用效果。

Minimally invasive surgery can be considered as the greatest innovation over the past 30 years in surgical field. It revolutionized surgical practice with well- proven advantages over traditional open surgery： reduced surgical trauma and incision- related complications, such as surgical- site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the reduction in- depth perception, camera instability, limited range of motion, and steep learning curves. Since the 1980s, The robotic surgical system has sprung up to over come the difficulties encountered with conventional laparoscopy, to augment the surgeon′s skills, achieve accuracy and high precision during complex surgery, and facilitate wide spread of MIS. Robotically assisted technology offers advantages that include improved three- dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision. Robotic surgery has emerged as an innovative minimally invasive approach in the field of gynecology with increasing frequency, especially in the field of gynecologic malignant tumor. We viewed the literature with the aim to assess and describe the applications of robot- assisted surgery in gynecologic oncology in terms as of its utility and outcome.