專題討論16:機器人手術最近的發展及運用
Recent Development and Application in Robotic Surgery

S16-4
Robotic-assisted Laparoscopic Pelvic Lymphadenectomy in Gynecologic Oncology.

Robotic-assisted surgery leverages the advantages of standard laparoscopy while restoring three-dimensional vision, ergonomic, intuitive controls, and wristed instruments that approximate the motion of the human hand. Robotic-assisted surgery has already shown feasibility and in many cases superiority to standard laparoscopy in urology and general and cardiothoracic surgery. The applications of robotic-assisted surgery are rapidly being incorporated into the field of gynecologic oncology.

Objective:
The objective of the study was to evaluate outcomes during the first year of a robotic surgery program in gynecologic oncology. And to evaluate the feasibility of integrating robotic-assisted technology in the performance of laparoscopic staging of gynecologic malignancies.

Methods:
The surgeries were performed with Da Vinci robotic system (Intuitive Surgical, inc., USA) including surgeon's console with stereoscopic viewer with hand and foot controls. The second component of the system was In Site vision system with 3D 12 mm endoscope. The third part comprised of 3 telerobotic arms with Endowrist instruments. We studied the initiation of a robotic surgery program with prospective data collection, including intraoperative times, estimated blood loss , length of hospital stay , lymph node yields, and complications.
Data were collected and analyzed as a retrospective case series analysis.

Results:
Nine patients underwent robot-assisted laparoscopic surgeries for gynecologic cancers from July 2007 to August 2008. Six patients with early stage endometrial cancer underwent robotic-assisted staging laparoscopy and three patients underwent robotic radical hysterectomy for early stage cervical cancer. The median lymph node count for lymphadenectomy was 24.8 (range, 9 to 30). Mean operating time was 200 minutes (range, 143 to 261) for cases with endometrial cancer and 286 minutes (range, 256 to 325) for cases with cervical cancer. The average estimated blood loss was 178 mL for cases with endometrial cancer and 200 ml for cases with cervical cancer. The median hospital stay was 3 days for cases with endometrial cancer and 5 days for for cases with cervical cancer. No conversion was required, and no technical incidents were observed in the robotic group. No intraoperative or postoperative complications occurred. All patients in this group are alive and free of disease at the time of last follow up.

Conclusion:
Robot-assisted laparoscopic staging is a feasible technique that may overcome the surgical limitations of conventional laparoscopy.

Although the benefit of this technique has not yet been established, predictable technological improvements would suggest the development of telesurgery and an improved precision of surgical procedure. We feel the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy.