Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
复制标题
机器人辅助全直肠系膜切除及盆腔外侧淋巴结清扫治疗局部晚期中低位直肠癌
DOI：
10.3791/62919
复制
发表时间：
2022-02-01
影响因子：
1.2
通讯作者：
She, Junjun
中科院分区：
文献类型：
--
作者：
Hu, Chenhao;Zhang, Zhe;She, Junjun
自获批临床使用以来，达芬奇手术机器人在胃肠外科手术，特别是复杂手术中显示出了很大的优势。高质量的3d视觉，多关节臂和自然震颤过滤使外科医生能够以最小的侵入更准确地暴露和解剖。全肠系膜切除术是治疗可切除直肠癌的标准手术技术。为降低外侧复发率，可行盆腔外侧淋巴结清扫术，对于局部晚期中低位直肠癌且外侧淋巴结转移可能性高，是一种安全可行的手术方法。但其解剖结构的复杂性和术后并发症的高发生率限制了其应用。最近，一些外科医生越来越多地使用机器人技术进行全肠系膜切除和骨盆外侧淋巴结清扫。与开放手术和腹腔镜手术相比，机器人技术具有失血少、输血少、创伤小、术后住院时间短、恢复快等优点。机器人方法通常被认为是复杂手术的合理选择，如骨盆外侧淋巴结清扫，尽管报告直接证据的高质量前瞻性随机对照研究数量有限。本文介绍了在西安交通大学第一附属医院进行的机器人辅助全肠系膜切除和盆腔外侧淋巴结清扫的详细步骤。
Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi'an Jiaotong University.