專題討論3:機器手臂手術的新進展
Da Vinci Robotic Surgery

程 序 表

S3-1
Robot-assisted Thoracic Surgery –Experience in NTUH
Jang-Ming Lee MD, Shuenn-Wen Kuo MD; Pei-Ming Huang MD; Hsao-Hsun Hsu MD; Jin-Shing Chen MD
Departments of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-San South Road, Taipei 100, Taiwan

  Minimally invasive surgery using thoracoscopy have been gradually adopted to be an effective surgical approache to treat various thoracic diseases. However, 2D-imaging system and limitation in instrument manipulation through a small port has long been criticized by some surgeons. With the novel robotic surgical system using 3-D high definition imaging and 7-degree of freedom for instrumentation, many thoracic surgical procedures have been reported to been safely and effective performed, including lobectomy, thymothymectomy and esophagectomy. We therefore set up a prospective study to evaluate the efficacy of thoracic surgery using the da Vinci system in the National Taiwan University Hospital. From February 2012 to July 2012, we performed thymothymectomy (1), lobectomy (15), esophagectomy (1) and excision of esophageal tumor (1). The median docking time of all procedures was 10.5 minutes (range, 4–21 minutes) and the median console time was 183 minutes (range, 72–327 minutes). No patient was converted to traditional laparoscopy or thoracoscopy but one patient was converted to open surgery due to major bleeding. The postoperative morbidities included one prolonged air leak, one atrial fibrillation, and one worsening of myasthenia gravis. There was no mortality. The median drain tube duration was 3 days (range, 2–11 days). And the median hospital stay was 6 days (range, 4–19 days). Robot-assisted thoracic surgery is proved to be feasible and safe in our initial series in a learning curve setting. A longer follow-up period and randomized controlled trials are necessary to evaluate a potential benefit over open and conventional VATS approaches.