Radical resection of gallbladder cancer: could it be robotic?
Radical resection of gallbladder cancer: could it be robotic?
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DOI：
10.1007/s00464-012-2330-4
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发表时间：
2012-11-01
影响因子：
3.1
通讯作者：
Li, Hong-Wei
中科院分区：
文献类型：
--
作者：
Shen, Bai-Yong;Zhan, Qian;Li, Hong-Wei
胆囊癌患者唯一可能的治疗选择是根治性切除。这是第一份描述微创机器人辅助根治性切除术（包括淋巴结切除术）在5例胆囊癌患者中成功应用的报告。在中国上海瑞金医院肝胆胰外科通过da芬奇机器人手术系统进行胆囊癌根治性切除术的患者病历，回顾分析2010年3月至2011年7月间5例患者的临床资料，机器人辅助下根治性切除均获成功。平均切除淋巴结数量为9个（范围= 3-11），平均手术时间为200分钟（范围= 120-300分钟），平均术中失血量为210 ml（范围= 50-400 ml），平均住院时间为7.4天（范围= 7-8天）。所有患者均出院，未报告并发症。平均术后随访11个月（范围= 1-17个月）。1例患者术后10个月因肿瘤复发死亡，其余4例患者随访期间无肿瘤复发，表明机器人辅助胆囊癌根治术是可行且安全的。与腹腔镜手术相比，机器人手术系统更适合在狭窄、深的空间进行精细解剖。这对于切除胰腺和肝十二指肠韧带附近的淋巴结以及肝十二指肠韧带、肝动脉和腹腔轴的再分化都是有利的。需要在更大的患者队列中进行长期结局和与剖腹手术的直接比较，以提供更多的临床数据支持该方法的优越性。
The only potentially curative option for patients with gallbladder cancer is radical resection. This is the first report that describes the successful application of a minimally invasive, robot-assisted radical resection, including lymphadenectomy, in five gallbladder cancer patients.Medical records of patients who underwent radical resection of gallbladder cancer via the da Vinci robotic surgical system in the Hepato-Bilio-Pancreatic Surgical Department of the Shanghai Ruijin Hospital, China, between March 2010 and July 2011 were reviewed and analyzed.Robot-assisted radical resection was successful in all five patients. The mean number of excised lymph nodes was 9 (range = 3-11), mean operative time was 200 min (range = 120-300 min), mean intraoperative blood loss was 210 ml (range = 50-400 ml), and mean length of hospital stay was 7.4 days (range = 7-8 days). All patients were discharged with no reported complications. Mean postoperative follow-up was 11 months (range = 1-17 months). One patient died due to tumor recurrence 10 months postsurgically, but there was no recurrence in the remaining four patients during the follow-up period.Robot-assisted radical resection for gallbladder cancer is both feasible and safe. Compared to laparoscopic surgery, the robotic surgery system is better suited for subtle dissection in a narrow, deep space. This is advantageous for both the removal of lymph nodes near the pancreas and hepatoduodenal ligament and the skeletonization of the hepatoduodenal ligament, the hepatic artery, and the celiac axis. The long-term outcome and direct comparisons to laparotomy in a larger patient cohort are needed to provide more clinical data supporting the superiority of this approach.