Robot-assisted microvascular anastomosis in head and neck free flap reconstruction: Preliminary experiences and results
Robot-assisted microvascular anastomosis in head and neck free flap reconstruction: Preliminary experiences and results
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DOI：
10.1002/micr.30458
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发表时间：
2019-11-01
期刊：
影响因子：
2.1
通讯作者：
Chen, I-Chen
中科院分区：
文献类型：
--
作者：
Lai, Chih-Sheng;Lu, Chen-Te;Chen, I-Chen
背景：达芬奇芬奇手术系统促进了手术的巨大进步。机器人辅助微血管吻合术在真实的临床情况下的过程和结果很少报道。本研究介绍了我们在口咽癌患者中进行机器人辅助微血管吻合的游离皮瓣重建的经验。患者和方法这是一项回顾性研究的重建手术，使用游离前臂桡侧皮瓣的口咽缺损后，肿瘤切除术在15个连续的成年患者（12名男性和3名女性）。共进行了17例机器人辅助微血管血管吻合术（2例动脉和15例静脉）;此外，使用标准手术显微镜和手工缝合技术进行了13例动脉和13例静脉吻合术。结果供、受体血管直径分别为2.5 ± 0.7mm和2.1 ± 0.8mm。采用da芬奇手术系统吻合的供体血管直径明显较小（2.1 +/- 0.8 vs. 2.5 +/- 0.6 mm）比标准手术显微镜和手工缝合技术（p = 0.021），手术时间（38.4 +/- 10.4 vs. 28.0 +/- 7.7 min）显著延长（p <0.001）。血管通畅率为100%，所有皮瓣均成活，无需再次手术翻修。结论机器人手术系统可以促进血管显微吻合，并提供与标准手术显微镜和手工缝合技术相当的血管通畅率。
Background The da Vinci Surgical System has facilitated considerable advancements in surgery. The process and results of robot-assisted microvascular anastomosis in real clinical situations have rarely been reported. This study presents our experience of performing robot-assisted microvascular anastomosis in free flap reconstruction in patients with oropharyngeal cancer. Patients and methods This was a retrospective study of reconstructive operations using a free radial forearm flap for oropharyngeal defects after tumor extirpation in 15 consecutive adult patients (12 men and 3 women). In total, 17 robot-assisted microvascular vessel anastomoses (2 arteries and 15 veins) were performed; moreover, 13 arteries and 13 veins were anastomosed using the standard operating microscope and hand-sewing technique. Results The recipient and donor vessel diameters were 2.5 +/- 0.7 and 2.1 +/- 0.8 mm, respectively. The donor blood vessel diameter selected for anastomosis using da Vinci Surgical System was significantly smaller (2.1 +/- 0.8 vs. 2.5 +/- 0.6 mm) than that for a standard operating microscope and hand-sewing technique (p = .021), the operating time spent (38.4 +/- 10.4 vs. 28.0 +/- 7.7 min) was significantly longer (p < .001). The vascular patency rate was 100%, and all flaps survived without requiring additional operation for revision. Conclusion Robotic surgical systems can facilitate vascular microanastomosis and provide a blood vessel patency rate comparable to that of a standard operating microscope and hand-sewing technique.