机器人自由基胆囊切除术：证明胆囊癌的开放手术的技术等效性
Robotic Radical Cholecystectomy: Demonstrating Technical Equivalence to Open Surgery in Gallbladder Cancer
影响因子:3.50000
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2024 Nov
作者:
Gurudutt P Varty, Shraddha Patkar, Kaival Gundavda, Niket Shah, Mahesh Goel
摘要
开放的根治性胆囊切除术是用于治疗胆囊癌的当前“黄金标准”。在精心挑选的患者中，机器人自由基胆囊切除术（RRC）可以是合适的替代方案，可立即提供术后效果，例如减少失血，较短的住院时间和更少的并发症，同时在肿瘤学上相当于。但是，它需要更长的学习曲线。1方法：该视频在执行门户淋巴结清扫术（第8、12和13号站）时展示了机器人方法的技术等效性，重点是撤回技术以模仿开放方法。在提出的情况下，一名40岁的女性患者患有腔内胆囊肿块，带有外围节点，如计算机断层扫描所示。患者接受了Davinci XI机器人系统进行的门户淋巴结清扫术的RRC。手术可以分为五个主要步骤：（1）在河道间区域中进行16B1节点采样； （2）右门淋巴结切除术（第13台，12b，12p）; （3）左侧门淋巴结清扫术（第8A，8P，12A，12P）; （4）前门淋巴结切除术（第12A，12B）; （5）胆囊切除术和肝楔切除术。将这些步骤中的每一个的技术细微差别与公开方法中的对应物进行比较，以证明等效性。 The key element in achieving a thorough oncological clearance is to replicate the retraction techniques of the open approach on the robotic platform by using vessel tapes for portal lymphadenectomy.There remains little doubt regarding the feasibility and early postoperative benefits of RRC.2 This video demonstrates the equivalence of a standardized technique of robotic portal lymphadenectomy and liver wedge resection to the open approach.但是，需要前瞻性研究来进一步评估该程序的长期益处。
Abstract
Open radical cholecystectomy is the current "gold standard" for the management of gallbladder cancer. In well-selected patients, robotic radical cholecystectomy (RRC) can be a suitable alternative offering immediate postoperative benefits, such as less blood loss, shorter hospital stay, and fewer complications, while being oncologically equivalent. However, it requires a longer learning curve.1 METHODS: This video demonstrates the technical equivalence of the robotic approach when performing portal lymphadenectomy (station 8, 12, and 13) with emphasis on retraction techniques to emulate the open approach. In the case presented, a 40-year-old female patient had an intraluminal gallbladder mass with periportal nodes as revealed by computed tomography. Patient underwent a RRC with portal lymphadenectomy, performed on the DaVinci Xi robotic system. The surgery can be divided into five major steps: (1) Station 16b1 node sampling in the inter-aortocaval region; (2) Right portal lymphadenectomy (station 13, 12b, 12p); (3) Left portal lymphadenectomy (station 8a, 8p, 12a, 12p); (4) Anterior portal lymphadenectomy (station 12a, 12b); and (5) Cholecystectomy with liver wedge resection. The technical nuances of each of these steps is compared with its counterpart in the open approach to demonstrate equivalence. The key element in achieving a thorough oncological clearance is to replicate the retraction techniques of the open approach on the robotic platform by using vessel tapes for portal lymphadenectomy.There remains little doubt regarding the feasibility and early postoperative benefits of RRC.2 This video demonstrates the equivalence of a standardized technique of robotic portal lymphadenectomy and liver wedge resection to the open approach. However, prospective studies are needed to further evaluate the long-term benefits of the procedure.