机器人胆囊切除术：展示其在胆囊癌中与开腹手术的技术等效性

Robotic Radical Cholecystectomy: Demonstrating Technical Equivalence to Open Surgery in Gallbladder Cancer

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ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

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

DOI: 10.1245/s10434-024-15952-z

摘要

开腹根治性胆囊切除术是胆囊癌治疗的“金标准”。在选择适当的患者中，机器人根治性胆囊切除术（RRC）可以作为一种替代方案，具有术后出血少、住院时间短、并发症少等优点，且在肿瘤学治疗效果上与开腹手术相当。然而，该技术的学习曲线较长。方法：本视频展示了机器人技术在进行门静脉淋巴结清扫（8区、12区及13区）中的等效性，重点强调牵引技术以模拟开腹操作。在病例中，一名40岁女性患者CT显示肠腔内胆囊肿块伴门静脉附近淋巴结，采用DaVinci Xi机器人系统进行RRC伴门静脉淋巴结清扫。手术主要分为五个步骤：(1) 交叉主动脉间区域的16b1淋巴结采样；(2) 右门静脉淋巴结清扫（13区、12b、12p）；(3) 左门静脉淋巴结清扫（8a、8p、12a、12p）；(4) 前方门静脉淋巴结清扫（12a、12b）；(5) 胆囊切除及肝楔形切除。每个步骤的技术细节与开腹操作相比较，以证明其等效性。实现彻底肿瘤清除的关键在于在机器人平台上复制开腹牵引技术，借助血管带进行门静脉淋巴结清扫。毫无疑问，RRC的可行性和早期术后优势已得到验证。该视频展示了标准化的机器人门静脉淋巴结清扫和肝楔形切除技术与开腹手术的等效性，但仍需前瞻性研究以评估其长期收益。

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.