微创手术平台与微创手术方式的未来走向

Future trend of minimally invasive surgery platform and surgical procedure

近30年来,随着能量平台、器械平台、显像平台三大手术平台的发展,微创外科有了突飞猛进的提升。以结直肠癌手术为例,手术方式的五要素都有着不同程度的发展:手术入路经历了"从大到小"的过程;切除范围从单纯肠段切除到根治术或扩大根治术,再到注重保留器官功能的手术;随着对正常淋巴引流方向和肿瘤淋巴转移特点的认知,淋巴结清扫愈趋规范;消化道重建从手工缝合到全腔镜下吻合,再到功能性吻合概念的提出;标本取出从经腹壁大切口,到腹腔镜小切口,再到经自然腔道。这些术式的演变都依赖于技术平台与设备的进步及对新理念的认知。未来微创平台一定是为保障最优化术式顺利实施为方向,平台更为安全化、一体化、多功能化、智能化;未来微创术式一定是以追求患者最大获益为目标,术式更为科学化、功能化、舒适化、多样化;而术式的革新又推动了平台的发展,二者相辅相成,互相促进。

In the past 30 years,minimally invasive surgery has been greatly improved with the development of the energy platform,instrument platform,and imaging platform.Taking colorectal cancer surgery as an example,the five elements of surgical procedure have developed to a certain extent.The surgical approach has undergone a process from large to small.The range of resection ranges from simple bowel resection to radical resection/extended radical resection,and then to surgery that focuses on preserving organ function.With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis,lymph node dissection has been gradually standardized.The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis,and then to the concept of functional anastomosis.The removal of the specimen has improved from large incision through the abdominal wall,to small laparoscopic incision,and then to the natural cavity.The evolution of these procedures depends on the advancement of technology platforms and equipment,and the recognition of new concepts.The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach.The platform is more secure,integrated,multifunctional,and intelligent.In the future,minimally invasive procedures must be aimed at maximizing the benefits of patients.The procedures are more scientific,functional,comfortable and diverse.Surgical innovation has promoted the development of the platform.The platform and the surgical procedure promote each other's development.