达芬奇机器人手术系统在头颈肿瘤外科的应用报道

Application of Da Vinci Xi Robotic Surgical System in Head and Neck Tumor Surgery

目的:探讨达芬奇机器人手术系统在头颈肿瘤外科应用中的安全性、可行性及手术技巧。方法:回顾性分析2022年6月至2023年7月在四川省肿瘤医院接受达芬奇机器人(Da Vinci Xi系统)手术的54例头颈部肿瘤患者的基本资料,包括肿瘤部位、病理类型、手术入路、手术时间、术中出血量、术后并发症、术后住院时间等。其中甲状腺手术41例,口咽部手术8例,腮腺手术3例,颌下腺手术2例。入路选择包括口腔入路、双侧腋窝和乳晕入路、单侧腋窝和乳晕入路(unilateral axilla-areola,UAA)及耳后入路。结果:54例患者均顺利完成机器人辅助手术,无中转开放手术。1例UAA甲状腺癌患者术后乳晕隧道出血再次内镜下止血,1例腋乳入路甲状腺癌腺叶切除患者术后发生术区感染。所有甲状腺手术患者术后无永久性甲状旁腺功能减退和永久性喉返神经麻痹发生。腮腺和颌下腺患者术后无面瘫、舌尖麻木、口底运动感觉异常等并发症发生,美观满意度高,疗效满意。结论:与传统开放手术入路相比,达芬奇机器人手术系统应用在头颈肿瘤外科手术中安全、可行,创伤小、并发症少,功能保护更具优势,美容效果显著,在目前开展成熟的甲状腺、口咽手术基础上,可向颌下腺、腮腺等部位拓展,具有良好的临床应用前景。

Objective:To explore the safety,feasibility,and surgical techniques of Da Vinci Xi robotic system in head and neck oncological surgery.Methods:A retrospective analysis was conducted on 54 patients with head and neck tumors who underwent Da Vinci Xi robotic system at Sichuan Cancer Hospital from June 2022 to July 2023.Patient data,including tumor location,pathological types,surgical approaches,operation time,intraoperative blood loss,postoperative complications and length of stay,were reviewed.The surgeries included 41 cases of thyroid surgery,8 cases of oropharyngeal surgery,3 cases of parotid gland surgery and 2 cases of submandibular gland surgery.Surgical approaches included oral approach,bilateral axillo-breast approach,unilateral axilla-areola approach and retroauricular approach.Results:All the 54 patients successfully completed robot-assisted surgery without conversion to open surgery.Endoscopic hemostasis was performed again in a patient with areolar tunnel hemorrhage treated by robotic thyroidectomy via axillo-breast approach,and postoperative infection occurred in 1 patient treated by robotic thyroidectomy via axillo-breast approach.Neither permanent hypoparathyroidism nor permanent recurrent laryngeal nerve paralysis occurred in patients treated with robotic thyroidectomy.After robotic surgery,patients with parotid and submandibular gland diseases had no complications such as facial paralysis,tongue tip numbness or the loss of motor and sensory functions of the mouth floor,and cosmetic and curative effects were satisfactory.Conclusion:Compared with the traditional open surgery,the Da Vinci Xi Robotic Surgical System is safe and feasible in head and neck cancer surgery,with less trauma and fewer complications,more functional advantages and significant cosmetic effects.Based on the experience in current mature thyroid and oropharyngeal surgery,it can be further used for the submandibular gland,parotid gland and other parts,which has a good clinical application prospect.