微创超声骨刀在机器人辅助骶骨肿瘤切除术中的应用

Application of minimally invasive ultrasonic osteotome in robotic-assisted sacral tumor resection

骶骨肿瘤切除手术难度高,并发症风险大。近年来机器人辅助骶骨肿瘤切除手术逐渐得到开展,但现有机器人器械难以切除骨组织,限制了手术机器人在骶骨肿瘤中的应用。本研究探索微创超声骨刀在机器人辅助骶骨肿瘤切除术中的应用范围和效果。2015年5月至2021年3月期间中山大学附属第一医院共18例骶骨肿瘤患者行达芬奇机器人辅助骶骨肿瘤切除术,回顾性选取3例术中使用微创超声骨刀进行截骨的骶骨肿瘤患者,男2例、女1例,年龄分别为24、32、71岁。神经鞘瘤2例,节细胞神经瘤1例。记录手术时间、出血量、术后住院时间,随访评估患者复发及并发症情况。3例手术时间分别为80、240、300 min,术中出血量为30、30、100 ml。2例完整切除骶骨,1例分块切除。术后住院时间分别为5、3、7 d;术后随访时间为58、17、31个月,随访期间未发现肿瘤复发。1例术后出现左足酸痛,无其他术中及术后并发症。超声骨刀联合手术机器人可实现精准截骨、减少术中出血、加速术后康复,对特定的骶骨肿瘤的治疗有突出优势。

Sacral tumors are surgically challenging and at a high risk of complications.In recent years,robotic-assisted resection has been gradually applied in sacral tumors,but it is difficult to remove bone tissue by present robotic instruments,which limits the application of surgical robot in sacral tumor.The present study aimed to explore the application range and therapeutic effect of minimally invasive ultrasonic osteotome in robotic-assisted sacral tumor resection.Eighteen patients underwent robotic-assisted sacral tumor resection in the First Affiliated Hospital of Sun Yat-Sen University from May 2015 to March 2021 by the Da Vinci robotic surgical system.Among them three patients who underwent osteotomy with minimally invasive ultrasonic osteotome were enrolled.There were 2 males and 1 female,aged 24,32,71 years,respectively.The tumors included 2 schwannomas and 1 ganglioneuroma.The operation time,bleeding volume and postoperative hospitalization days were recorded.The recurrence and complications were evaluated during follow-up.The operative time of the 3 patients was 80,240 and 300 minutes,and the intraoperative bleeding volume was 30,30 and 100 ml.Complete resection was performed in 2 cases and intralesional resection in 1 case.The postoperative hospital stay was 5,3 and 7 days respectively.The follow-up time was 58,17 and 31 months respectively.No tumor recurrence was found during the follow-up.As regards complications,only one patient had left foot pain after operation,and there were no other intraoperative or postoperative complications.The therapeutic advantages of ultrasonic osteotome combined with the Da Vinci robotic surgical system can achieve precise osteotomy,reduce intraoperative bleeding and accelerate postoperative recovery for certain patients with sacral tumors.