机器人直肠癌手术现状

Robotic rectal cancer surgery

机器人具有手术野放大、真实三维成像、机械手腕7个自由度灵巧运动、无震颤、运动缩放、学习曲线短、人机亲和、显微手术等优势,克服了腹腔镜的局限性,更加适合直肠癌手术,尤其是骨盆狭窄的病人。据报道,机器人直肠手术可以降低中转开腹率,但手术时间更长,手术后短期临床疗效与传统的腹腔镜手术相似,肿瘤预后也相当。机器人全直肠系膜切除术(TME)手术在自主神经功能保护方面的优越性能够降低病人性功能及排尿功能障碍。直肠癌机器人手术安全、可行,仍然需要团队培训与合作,成本效益指标有待进一步优化。有关机器人直肠癌根治术对病人近期结局、生活质量及预后的影响亟待设计良好的多中心RCT研究证实。

Robotic surgery overcomes the limitations of conventional laparoscopy associated with anatomy and offers certain advantages,including magnification,virtual 3-D imaging,flexible wrist with sev-en degree of freedom,dexterity,superior microsurgical capabilities,lack of tremors,motion scaling,a short learning curve and friendly man-machine interface.The tight confines of the deep narrow pelvis make the robot a good match for med-low rectal surgery.Robotic rectal surgery has been shown to reduce conver-sions as compared to laparoscopic surgery in the majority of studies,but it is associated with longer opera-tive times than the conventional laparoscopic approach.Preliminary research shows that postoperative short-term outcome and long-term prognosis are equivalent between the two approaches.The possible supe-riority of robotic surgery in terms of the preservation of autonomic function allows for the preservation of u-rinary and sexual functions after nerve preserving TME.Even so,it should be emphasized that the coopera-tion and training for members of the surgical team will be required and the costs and benefits still needs to be further improved and optimized.The effects of robotic rectal cancer resection on the short-term out-come,quality of life and prognosis of patients need to be investigated and validated by a rigorous desiged multicenter RCT study.