机器人辅助下胃癌手术第一助手的配合

机器人胃癌手术中第一助手的作用不可或缺,甚至能决定手术的成败.助手的工作应从术前准备开始,包括与患者、术者、手术室护士的沟通,体位的选择,切口的位置及穿刺器(Trocar)的布局,机械臂的调整及助手站位的选择;术中配合术者悬吊肝脏,牵拉暴露止血,以及消化道重建等;术后对于每一台手术进行及时总结并改进,与术者及时交流才能在手术中快速提高自身技能,配合术者流畅完成一台机器人胃癌手术.     

腹腔镜辅助远端胃癌根治术助手配合技巧

尽管腹腔镜辅助胃癌根治术的远期疗效还缺乏大样本随机对照研究的结果来证实．但许多报道均显示出其安全性和有效性。单从技术角度而言．腹腔镜辅助胃癌根治术可以达到D,淋巴结清扫效果。腹腔镜胃癌根治术要求进行胃周间隙的多方位、多层次解剖分离,广泛的胃周淋巴结清扫．手术的操作难度较大,而且术者缺乏触觉反馈;     

机器人辅助胃癌根治术的安全性及可行性分析

目的:探讨手术机器人在胃癌根治术中的安全性及可行性.方法:回顾性分析2016年1月～2019年3月在甘肃省普外临床医学中心行胃癌根治术282例患者的病例资料.行达芬奇机器人胃切除手术(Robot-assisted gastrectomy,RAG)者为RAG组(137例),行腹腔镜胃切除手术(Laparoscopy assisted gastrectomy,LAG)者为LAG组(145例).比较两组患者的手术时间、术中出血量、淋巴结清扫数目等.按手术先后顺序对RAG组进行分组,确定机器人胃切除手术的学习曲线.结果:与LAG组比较,RAG组淋巴结清扫数目更多[(25.12±10.54)枚Vs?(21.54±9.25)枚,P=0.03),术后住院时间更短[(13.36±3.00)d Vs(15.30±3.89)d,P<0.001].而两组患者在手术时间、总并发症发生率、术中出血量方面,差异无统计学意义(P>0.05).根据手术先后顺序对RAG组进行分组,经统计分析可知机器人胃切除手术的学习曲线为7例.结论:在胃癌根治术中,机器人手术术后恢复更快,淋巴结清扫更彻底,具备腹腔镜技术的医师更容易学习并掌握机器人手术.     

单中心机器人辅助胃癌根治术的学习曲线

目的:探讨机器人根治性远端胃与全胃切除术的学习曲线。方法:回顾分析2020年8月至2022年8月47例机器人根治性远端胃切除术与32例机器人根治性全胃切除术的临床资料,年龄、BMI、出血量、手术时间、术后住院时间、淋巴结清扫数量等计量资料采用独立样本t检验;术后并发症发生率、性别等计数资料采用χ²检验,按照手术时间顺序收集并分析病例资料,每种手术以手术时间为参数进行累积与分析并构建学习曲线,找出曲线转折点。结果:机器人根治性远端胃与全胃切除术的学习曲线分别在28例、16例出现转折点。机器人根治性远端胃切除术学习曲线转折点的前后两组在性别、年龄、BMI、出血量、手术时间、清扫淋巴结数量方面差异均无统计学意义(P>0.05),但转折点前后两组术后住院时间、术后并发症发生率差异有统计学意义(P<0.001,P=0.027)。机器人根治性全胃切除术学习曲线转折点前后两组患者的年龄、BMI、出血量、清扫淋巴结数量、手术时间、并发症发生率差异均无统计学意义(P>0.05),性别差异有统计学意义(P=0.033)。结论:跨越机器人根治性远端胃切除术与全胃切除术...     

达芬奇机器人辅助胃癌根治术相关问题

人工智能手术系统辅助手术是近年来发展起来的一项外科新技术。目前临床上多采用美国IntuitiveSurgieal公司研发的达芬奇S系统（达芬奇机器人）进行手术操作。与普通腹腔镜系统相比,该系统采用了3D摄像、动作缩减、震颤过滤和多自由度操作器械等技术,为术者提供了高清晰度的立体术野图像,显露更完美,操作时手眼协调性更好,便于进行精细分离、切割、止血、缝合和打结,操作稳定性高。     

腹腔镜胃癌根治术团队中助手的配合与体会

近年来,腹腔镜胃癌根治手术报道逐渐增多[1-6].因胃癌根治术操作流程复杂,难度大,故在腹腔镜下完成胃癌根治术对操作人员的腹腔镜操作技巧要求高[7].在进行腹腔镜胃癌根治术的团队中,主要成员为术者、助手和扶镜者,其中,助手的高质量手术协助对高效率完成手术具有重要意义.     

达芬奇机器人胃癌根治术临床疗效评价

目的探讨达芬奇机器人胃癌根治术的可行性及近期疗效。方法回顾性分析我科2012年2月-2014年5月手术治疗的114例胃癌患者的临床、病理资料。其中50例患者行机器人远端胃癌根治术,64例患者行腹腔镜远端胃癌根治术,比较两组患者手术情况及短期疗效。结果与腹腔镜组相比,机器人组患者术中失血量少、淋巴结清扫数目多、手术时间长,比较差异有统计学意义（P〈0.05）;术后胃肠道功能恢复时间、术后住院时间及并发症发生率,比较差异无统计学意义。中位随访16.1（3～30）个月,机器人组复发转移5例,死亡4例;腹腔镜组复发转移10例,死亡8例。结论对比腹腔镜胃切除术,达芬奇机器人胃癌根治术能获得较大的淋巴结清扫范围,且出血量少、安全、可行。     

达芬奇机器人辅助胃癌根治术的相关问题探讨

1994年经美国FDA批准,自动定位内镜系统作为机器人持镜手应用于普通外科临床,此后又开发了宙斯机器人系统,但FDA仅批准其作为外科手术助手而不能作为真正的手术者。2000年7月,美国FDA正式批准了IntuitiveSurgical公司研发的达芬奇机器人手术系统应用于临床外科治疗,在此后几年中,应用达芬奇机器人手术系统相继开展了胆囊切除术、胃底反折术、Heller肌切除术、胃旁路术、结肠切除术等腹部外科手术。     

腹腔镜胃癌根治术中助手配合的要点和技巧

腹腔镜胃癌根治术要求进行胃周间隙的多方位和多层次解剖分离,其淋巴结清扫范围较广,手术操作复杂,需要良好的团队配合,尤其是助手的牵拉与暴露在手术中起到十分关键的作用。能与主刀默契配合的功能型助手能够使手术时间缩短,术中出血减少,提高手术质量。助手的成长需要时间和手术例数的积累,除应具备一定开腹胃癌根治术的经验外,还应熟练掌握术中各种腹腔镜器械的使用和操作技巧,保持与主刀一致的手术思路。要想尽快成为腹腔镜胃癌手术优秀而全面的助手,应不断学习及总结以缩短自己的学习曲线。     

腹腔镜胃癌根治术淋巴结清扫中功能型助手配合技巧

正在腹腔镜胃癌手术中,一位合格的助手可发挥重要作用,尤其是在初期开展的团队中显得更为重要。与简单完成暴露工作的支架型助手不同,功能型助手除了要实现良好的手术视野显露外,还应主动协助主刀完成解剖间隙和组织的分离,积极参与手术进程。本文结合笔者团队3000例腹腔镜胃癌手术的配合经验和相关文献,就腹腔镜胃癌根治术中淋巴结清扫时功能型助手的配合技巧进行阐述。1助手站位和trocar位置助手的站位决定其牵拉暴露位置,故了解功能型助手     

Full robot-assisted gastrectomy: surgical technique and preliminary experience from a single center

The treatment of gastric cancer requires a multidisciplinary approach in which surgery plays the main role. The diffusion of minimally invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended lymphadenectomy. This surgical step can be facilitated through the use of a robot-assisted system. To date, there are few published articles discussing a full robotic approach that precisely show the different surgical steps. The aim of this study is to describe our experience, surgical techniques and the short-term results of a consecutive series of full robotic gastrectomies using the Da Vinci Surgical System. From November 2011 to January 2015, 17 patients with gastric cancer underwent curative resection by robotic approach for locally advanced tumors. In summary, there were 15 total gastrectomies with a Roux-en-Y esophagojejunostomy, one total gastrectomy with transverse colectomy and one sub-total gastrectomy. Resection margins were negative in all cases. Conversions occurred in two patients. Robot-assisted gastrectomy with extended lymphadenectomy is a safe technique and successfully allows an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity. The learning curve appears to be shorter than in laparoscopic surgery. Further follow-up and randomized clinical trials are required to confirm the role of a robotic approach in gastric cancer surgery.     

机器人辅助胃癌根治术的Meta分析

机器人手术已在全球多个学科领域中广泛应用,机器人辅助胃癌切除术在微创外科领域也已取得长足发展.多项回顾性分析和非随机前瞻性研究均已报道了机器人根治性胃切除术的安全性和可行性.但是,相较于腹腔镜手术,机器人辅助胃癌切除术的优越性尚未完全证实.本研究主要在从技术方面对最新的相关证据进行分析,探讨机器人辅助胃癌切除术的优势.     

Experience implication in subjective surgical ergonomics comparison between laparoscopic and robot-assisted surgeries

Laparoscopic surgery (LS) may lead to musculoskeletal disorders (MSDs) and an increase in physical and mental workloads to the surgeon. Robot-assisted surg     

功能型助手在腹腔镜胃癌根治术中的作用

目的:比较腹腔镜辅助胃癌根治术中功能型助手与支架型助手的作用.方法:回顾分析2017年1月至2019年12月收治的122例行腹腔镜辅助胃癌根治术(全胃切除,食管-空肠Roux-en-Y吻合术)患者的临床资料.其中,60例为支架型助手组(对照组),62例为功能型助手组(研究组).对比分析两组围手术期及近期随访情况.结果:...     

Multipurpose surgical robot as a laparoscope assistant

Background

This study demonstrates the effectiveness of a new, compact surgical robot at improving laparoscope guidance. Currently, the assistant guiding the laparoscope camera tends to be less experienced and requires physical and verbal direction from the surgeon. Human guidance has disadvantages of fatigue and shakiness leading to inconsistency in the field of view. This study investigates whether replacing the assistant with a compact robot can improve the stability of the surgeon’s field of view and also reduce crowding at the operating table.

Methods

A compact robot based on a bevel-geared “spherical mechanism” with 4 degrees of freedom and capable of full dexterity through a 15-mm port was designed and built. The robot was mounted on the standard railing of the operating table and used to manipulate a laparoscope through a supraumbilical port in a porcine model via a joystick controlled externally by a surgeon. The process was videotaped externally via digital video recorder and internally via laparoscope. Robot position data were also recorded within the robot’s motion control software.

Results

The robot effectively manipulated the laparoscope in all directions to provide a clear and consistent view of liver, small intestine, and spleen. Its range of motion was commensurate with typical motions executed by a human assistant and was well controlled with the joystick.

Conclusions

Qualitative analysis of the video suggested that this method of laparoscope guidance provides highly stable imaging during laparoscopic surgery, which was confirmed by robot position data. Because the robot was table-mounted and compact in design, it increased standing room around the operation table and did not interfere with the workspace of other surgical instruments. The study results also suggest that this robotic method may be combined with flexible endoscopes for highly dexterous visualization with more degrees of freedom.