Robotic extended cholecystectomy in gallbladder cancer
Robotic extended cholecystectomy in gallbladder cancer
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DOI：
10.1007/s00464-020-07554-z
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发表时间：
2020-04-18
影响因子：
3.1
通讯作者：
Jang, Jin-Young
中科院分区：
文献类型：
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作者：
Byun, Yoonhyeong;Choi, Yoo Jin;Jang, Jin-Young
背景微创手术（MIS）在需要扩大胆囊切除术的晚期胆囊癌（GBC）中的应用具有挑战性，因为要实现临床安全和完整的肿瘤切除。然而，最近开发的机器人系统，可以提供克服腹腔镜MIS所面临的困难的优势。本研究的目的是探讨机器人系统的可行性和优势，以协助扩大胆囊切除术。方法2018年2月至2020年1月，对临床疑似T2期或以上GBC（术前CT或超声检查确定）的患者进行了机器人扩大胆囊切除术（REC）。随附的视频按以下顺序显示了详细的手术过程：患者和套管针的定位、Kocher手法、淋巴结清扫（#8、9、12、13）、肝十二指肠韧带切除、胆囊管结扎和肝脏切除。结果16例患者行REC，平均手术时间198.3min，术中出血量295ml。11例（68.8%）患者病理诊断为T2或以上期，3例（18.8%）患者发现转移淋巴结。所有病例均获得了无肿瘤切缘，3例（18.8%）患者显示肝实质受侵。平均回收淋巴结数为7.2。平均住院时间为7天。术后90天内无死亡或复发。结论机器人系统可安全用于晚期GBC，有利于肿瘤充分淋巴结清扫和快速恢复。
Background The application of minimally invasive surgery (MIS) in advanced gallbladder cancer (GBC) requiring extended cholecystectomy is challenging, in terms of achieving clinically safe and complete oncologic resection. Recently developed robotic systems, however, may provide advantages in overcoming difficulties faced by laparoscopic MIS. The purpose of this study is to investigate the feasibility and advantages of a robotic system to assist with extended cholecystectomy. Methods Patients diagnosed with clinically suspected stage T2 or above, GBC (as determined by preoperative computed tomography or ultrasonography) underwent robotic extended cholecystectomy (REC) from February 2018 to January 2020. The attached video shows the detailed procedure in the following order: the positioning of the patient and the trocars, Kocher maneuver, lymph node dissection (#8, 9, 12, 13), skeletonization of hepatoduodenal ligament, ligation of the cystic duct and liver resection. Results Of 16 patients who underwent REC, mean operation time was 198.3 min and the median estimated blood loss was 295 ml. 11 patients (68.8%) were pathologically diagnosed as stage T2 or above, and the metastatic lymph node was identified in 3 patients (18.8%). All cases had secured tumor-free resection margins, and 3 patients (18.8%) showed invasion to the hepatic parenchyma. The mean number of retrieved lymph nodes was 7.2. The median duration of hospital stay was 7 days. There were no mortality or recurrence within 90 days after the operation. Conclusion This study suggests that robotic systems can be safely utilized in advanced stage GBC, facilitating oncologically sufficient lymph node dissection and rapid recovery.