專題討論2:高科技醫療機械人手術

S2-2
達文西手術於肝膽胰及胃腸道疾病的應用與發展
彭正明主任
中山醫學大學附設醫院達文西微創手術中心

Purpose:
Minimally invasive surgery including laparoscopic and robotic surgery was recently approved for clinical use in hepatobiliopancreatic(HBP) and gastrointestinal(GI) surgery. The purpose of this article is to evaluate the feasibility and technical aspects of robotic single incisional laparoscopic surgery(RSILS) in HBP and GI surgery using the GelPoint , LAGIS Port and Glove Port in a preliminary study.
Materials and Methods:
From January 2012 to September 2016, we collected 55 patients with da Vinci single incision hepatectomy. Perioperative outcomes, including blood loss, transfusion requirements, complications, and length of stay (LOS) were assessed as same as conventional robotic surgery but postoperative pain is less than conventional robotic surgery. All robotic SILS procedures were completed (81/81, 100%).16 patients with da Vinci total gastrectomy with lymph node dissection. There was 10 gastric cancer and 6 gastric stump cancer. Age from 38 years old to 92 years old was noted. 48 patients underwent Robotic single port pancreaticoduodenectomy (RSPPD) between January 2012 and September 2016 were analyzed by one surgeon. 25 patients with pure RSPPD and 23 patients with single port plus one technique.
Results:
All procedure were safely performed under the da Vinci Si system. robotic SILS procedures were completed (55/55, 100%). The hepatectomy was safely performed in average operating times of 95 min (±25), with minimal blood loss. There was 46 pure single port hepatectomy and 9 single port plus one ( LAGIPORT: 12,Glove Port:38, Gelpoint:5). There were no conversions and no extension of the skin incision. Median hospital stay were 8 days (range: 5~13days). The RSPTG were safely performed in average operating times of 230 min (±45). There was no conversion to open approach, one wound infections, minimal blood loss. One pneumonia with medical treatment. Median lymph node dissection number was 26 (arrange: 21~ 72). Median hospital stay was 12 days (arrange:10~ 20 days).4 patients with conversion to single port plus one occurred. The robotic group had a significantly longer operative time ( mean: 405min), reduced blood loss (mean: 480 cc ), and shorter hospital stay( mean:25.5 days).
Conclusion:
   Robotic single incision surgery in HBP and GI surgery is technically feasible and safe in well selected patients.Using the commercial port such as LAGIS Port(Taiwan), Gelpoint(USA) and Glove port(S.Korea) as a single-incision access platform. Robotic SILS is easily established and is enormously advantageous to the well selected patient.