An update on robotic thoracic surgery and anesthesia
An update on robotic thoracic surgery and anesthesia
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DOI：
10.1097/aco.0b013e3283336547
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发表时间：
2010-02-01
影响因子：
2.5
通讯作者：
Campos, Javier H.
中科院分区：
文献类型：
--
作者：
Campos, Javier H.
综述目的微创手术累及胸腔的案例持续增加。随着机器人系统的引入，特别是十多年前的达芬奇机器人系统，胸部手术已经取得了一些令人兴奋的结果和有限的优势。本综述概述了机器人系统进行的常见胸外科手术，并讨论了其麻醉意义。关于该主题的文献目前包括使用机器人系统的病例报告或一系列临床前瞻性或回顾性观察报告，涉及胸腔（纵隔肿块切除术、肺叶切除术和食管切除术）；不幸的是，关于使用该技术的麻醉影响或并发症的报道非常有限。大多数外科报告涉及在胸外科手术中使用肺隔离装置，特别是使用双腔气管内管（DLT）；一些中心使用二氧化碳（CO2）充气作为其管理的一部分，以达到最大的手术暴露，同时压缩肺的手术侧远离手术区域。摘要：在参与需要机器人系统的胸外科病例时，麻醉师必须熟悉肺隔离技术和柔性纤维支气管镜检查。此外，预防和识别潜在的并发症，如挤压损伤或神经损伤，必须寻求。由于存在转开胸手术的可能性，因此如果出现这种情况，必须采取所有措施对患者进行相应的管理。
Purpose of reviewMinimally invasive surgery involving the thoracic cavity continues to increase. With the introduction of robotic systems, particularly the da Vinci robot system more than 10 years ago, thoracic operations have been performed with some provocative results and limited, defined advantages. The present review provides an overview of common thoracic surgical procedures performed with the robotic system and discusses the anesthetic implications.Recent findingsThe literature on this topic currently includes case reports or series of clinically prospective or retrospective observational reports with the use of robotic systems, involving the thoracic cavity (mediastinal mass resections, lobectomies, and esophagectomies); unfortunately there are very limited reports related to anesthetic implications or complications related to the use of this technology. The majority of the surgical reports involve the use of lung isolation devices for thoracic surgery, specifically the use of a double-lumen endotracheal tube (DLT); a few centers use carbon dioxide (CO2) insufflation as part of their management to achieve maximal surgical exposure while compressing the operative side of the lung away from the operative area,SummaryAnesthesiologists must be familiar with lung isolation techniques and flexible fiberoptic bronchoscopy while participating in thoracic surgical cases that require robotic systems. In addition, prevention and recognition of potential complications, such as crushing injuries or nerve damage, must be sought. Because the potential for converting to an open thoracotomy exists, all measures must be taken to manage patients accordingly if the situation arises.