场景式扶镜法在头侧中间入路3D腹腔镜左半结肠游离中的应用体会

The scene-guided technique of camera assistant for the left colon mobilization by cephalic middle approach in 3D laparoscopic surgery

目的:探讨头侧中间入路3D腹腔镜直肠癌手术中应用场景式扶镜法游离左半结肠的可行性。方法:以手术图片描述场景式头侧中间入路3D腹腔镜左半结肠游离扶镜技术的关键要点。将2020年4月至2022年5月采用场景式扶镜技术行头侧中间入路3D腹腔镜直肠癌左半结肠游离的41例患者归入场景组,将2019年1月至2020年3月采用传统扶镜法的37例患者归入传统组,对比分析两组左半结肠游离时间、术中出血量等。结果:场景组与传统组左半结肠游时间差异有统计学意义[(60.9±13.3)min vs.(70.1±13.9)min,P<0.05],术中出血量[(35.0±13.6)mL vs.(39.2±13.6)mL]、淋巴结清扫数量[(11.9±4.9)枚vs.(12.9±4.4)枚]、术后住院时间[(7.7±3.4)d vs.(8.0±4.3)d]、术后并发症(5 vs.4)差异无统计学意义(P>0.05)。两组术后随访6~12个月,均无局部复发或转移。结论:相较传统扶镜法,头侧中间入路3D腹腔镜直肠癌手术中应用场景式扶镜法游离左半结肠可明显缩短手术时间,术者操作更加流畅。

Objective:To investigate the feasibility of the scene-guided technique of camera assistant in the left colon mobilization by cephalic middle approach in 3D laparoscopic surgery.Methods:The key points of scene-guided technique of camera assistant in the left colon mobilization by cephalic middle approach in 3D laparoscopic surgery was demonstrated with surgical pictures.From Apr.2020 to May 2022,41 patients underwent left colon mobilization in 3D laparoscopic rectal cancer surgery using the scene-guided technique(scene group).From Jan.2019 to Mar.2020,37 patients underwent the same procedure using the conventional method(traditional group).A comparative analysis was conducted on the time of left colon mobilization and the intraoperative blood loss between the two groups.Results:The operation time for the left colon mobilization in the scene group was(60.9±13.3)min,which was significantly less than(70.1±13.9)min in the traditional group.There were no statistical differences in intraoperative blood loss[(35.0±13.6)mL vs.(39.2±13.6)mL],number of lymph node dissected[(11.9±4.9)vs.(12.9±4.4)],postoperative hospital stay[(7.7±3.4)d vs.(8.0±4.3)d]and postoperative complications(5 vs.4)between the two groups(P>0.05).Both groups were followed up for 6-12 months,and there was no local recurrence or metastasis.Conclusions:Compared with the traditional method,the scene-guided technique of camera assistant for the left colon mobilization by cephalic middle approach in 3D laparoscopic surgery can significantly shorten the operation time,and the operator can obtain better operative fluency.