有人建议采用机器人和腹腔镜平台的模块化组合使用来解决最佳工作空间利用方面的挑战。 3 臂按需开放式 Dexter 机器人系统的开发将狭小空间内机器人辅助精密手术的优势与较大空间内频繁变换位置的腹腔镜方法相结合。该系统集成了 2 个患者推车、一个完全可控的内窥镜臂和一个无菌外科医生开放控制台，允许在机器人辅助手术和腹腔镜手术之间快速切换。切换时，机械臂可以在手术过程中随时折叠到腹腔镜原始位置，从而可以不受限制地接近患者。切换需要 15-30 秒，在返回机器人模式后无缝地进行，无需重新对接或重新校准。在肿瘤性结直肠切除过程中，一些手术步骤（例如中央血管结扎和淋巴结切除术）最适合机器人方法，提供与 3 维视觉、改进的人体工程学和有限空间内的灵活性相关的优势。相比之下，腹腔镜平台更适合需要在大工作空间内频繁移动的手术步骤（例如，结肠的横向到内侧动员）。 Dexter 系统提供了由 7 种机器人仪器组成的产品组合，具有单极和双极功能，可与任何现有的可用发电机一起运行。此外，现有的手术室设备，包括吹气装置、光学器件和套管针，都可以与 Dexter 机器人平台一起使用。最近，作者所在机构首次发表的临床经验涉及 12 个试点病例，证明了针对良性和恶性适应症的右半结肠切除术以及腹侧网状直肠固定术的安全性和可行性。版权所有 © 2024 Elsevier Inc. 保留所有权利。

A modular, combined use of robotic and laparoscopic platforms has been suggested to address challenges in optimal workspace utilization. The 3-arm on-demand open Dexter Robotic System was developed to combine the advantages of robot-assisted precision surgery in narrow spaces with the laparoscopic approach for frequent position changes in larger spaces. The system integrates 2 patient carts, a fully controllable endoscope arm, and a sterile surgeon open console, allowing for a rapid switch between robot-assisted surgery and laparoscopy. When switching, the robotic arms may be folded into a laparoscopic home position at any time during a procedure, allowing unrestricted access to the patient. Switches take 15-30 seconds, occurring seamlessly without redocking or recalibrating upon returning to the robotic mode. During oncologic colorectal resections, some procedure steps (eg, central vessel ligation and lymphadenectomy) are best suited for the robotic approach, providing advantages related to 3-dimensional vision, improved ergonomics, and improved dexterity within confined spaces. In contrast, the laparoscopic platform is better suited for procedure steps requiring frequent movements within a large workspace (eg, lateral to medial mobilization of the colon). The Dexter system provides a portfolio of 7 robotic instruments with monopolar and bipolar function operating with any existing available generator. Furthermore, existing operating room equipment, including insufflating devices, optics, and trocars can be used with the Dexter robotic platform. Recently, the first published clinical experience from the authors' institution, involving 12 pilot cases, demonstrated the safety and feasibility for right colonic resections for benign and malignant indications and ventral mesh rectopexies.Copyright © 2024 Elsevier Inc. All rights reserved.