Zhang Shuhao,Gao Zhigang,Tou Jinfa,et al.Current applications of robotic procedures in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(08):701-707.[doi:10.12260/lcxewkzz.2021.08.001]
机器人手术在小儿外科领域的应用现状
- Title:
- Current applications of robotic procedures in pediatric surgery
- Keywords:
- Robotic Surgical Procedures; Laparoscopy; Thoracoscopy; Urologic Surgical Procedures; Thoracic Surgical Procedures; Surgical Procedures; Operative/General Surgery
- 分类号:
- R726;R726.1
- 摘要:
- 腹腔镜手术和胸腔镜手术在小儿外科领域发展迅速,部分情况下甚至已经取代开腹手术和开胸手术。尽管腔镜手术后康复快且伤口瘢痕小,但受到腔镜设备操作精度、灵活性以及二维手术视野的限制,腔镜手术并没有在复杂的器官重建手术中得到广泛应用。儿童患者组织脆弱和有限的手术操作空间对微创手术提出了更大的挑战。2001年,儿童机器人手术首次被报道,其仿真手腕机械臂、3D手术视野、7个自由度旋转以及震颤过滤弥补了腔镜手术的不足。之后二十年间,机器人手术在小儿外科领域得到了广泛应用。本文阐述机器人手术在小儿普外科、泌尿外科以及心胸外科的应用现状及其较传统手术方式的优劣。
- Abstract:
- Laparoscopy and thoracoscopy have developed so rapidly within the field of pediatric surgery as to even replace open surgery in some situations. Although mini-invasive surgery offers minimal surgical scars and shorter hospital stays, widespread use in complex organic reconstruction is hindered due to the drawbacks of device accuracy, poor dexterity with laparoscopic instruments and two-dimensional vision. Especially in children, fragile tissues and limited operating space pose huge challenges to mini-invasive surgery. First reported in 2001, pediatric robotic surgery has overcame many obstacles of mini-invasive surgery with its 4th arm for retraction, 3-D visualization, 7-degree range of motion and tremor elimination. During the ensuing two decades, robotic surgery developed rapidly. This review summarized current applications and its superiorities of pediatric robotic surgery in general surgery, urology and cardiothoracic surgery.
参考文献/References:
1 Cundy TP, Harley SJD, Marcus HJ, et al. Global trends in paediatric robot-assisted urological surgery:a bibliometric and Progressive Scholarly Acceptance analysis[J]. Journal of Robotic Surgery, 2017, 12(10049):1-7. DOI:10.1007/s11701-017-0703-3.
2 Gundeti M, Kearns J.Pediatric robotic urologic surgery-2014[J]. Journal of Indian Association of Pediatric Surgeons, 2014, 19(3):123. DOI:10.4103/0971-9261.136456.
3 Morales-López RA, Pérez-Marchán M, Pérez Brayfield M.Current concepts in pediatric robotic assisted pyeloplasty[J]. Frontiers in Pediatrics, 2019, 7:4. DOI:10.3389/fped.2019.00004.
4 Avery DI, Herbst KW, Lendvay TS, et al. Robot-assisted laparoscopic pyeloplasty:Multi-institutional experience in infants[J]. J Pediatr Urol, 2015, 11(3):139.e1-e5. DOI:10.1016/j.jpurol.2014.11.025.
5 Light A, Karthikeyan S, Maruthan S, et al. Peri-operative outcomes and complications after laparoscopic vs robot-assisted dismembered pyeloplasty:a systematic review and meta-analysis[J]. BJU Int, 2018, 122(2):181-194. DOI:10.1111/bju.14170.
6 吕逸清, 谢华, 黄轶晨, 等. 传统腹腔镜与机器人辅助腹腔镜技术在儿童肾盂成形术中的临床应用对比[J]. 中华小儿外科杂志, 2019, 40(1):41-44. DOI:10.3760/cma.j.issn.0253-3006.2019.01.009. Lü YQ, Xie H, Huang YC, et al. Clinical analysis of conventional laparoscopic versus robotic-assisted laparoscopic pyeloplasty in children[J]. Chin J Pediatr Surg, 2019, 40(1):41-44. DOI:10.3760/cma.j.issn.0253-3006.2019.01.009.
7 刘德鸿, 周辉霞, 马立飞, 等. 机器人辅助腹腔镜肾盂成形术治疗小婴儿肾积水的初步经验[J]. 中华泌尿外科杂志, 2019, 40(1):2-7. DOI:10.3760/cma.j.issn.1000-6702.2019.01.001. Liu DH, Zhou HX, Ma LF, et al. Initial experience of robotic-assisted laparoscopic pyeloplasty in the treatment of infants with ureteropelvic junction obstruction[J]. Chinese Journal of Urology, 2019, 40(1):2-7. DOI:10.3760/cma.j.issn.1000-6702.2019.01.001.
8 Minki B, Koh CJ.Lessons learned over a decade of pediatric robotic ureteral reimplantation[J]. Investigative & Clinical Urology, 2017, 58(1):3-11. DOI:10.4111/icu.2017.58.1.3.
9 黄轶晨, 谢华, 吕逸清, 等. 机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流[J]. 临床小儿外科杂志, 2020, 19(2):150-154. DOI:10.3969/j.issn.1671-6353.2020.02.012. Huang YC, Xie H, Lü YQ, et al. Preliminary experience of Lich-Greqoir robotic assisted laparoscopic ureteral reimplantation in children with primary vesicoureteral reflux[J]. J Clin Ped Sur, 2020, 19(2):150-154. DOI:10.3969/j.issn.1671-6353.2020.02.012.
10 曹华林, 周辉霞, 马立飞, 等. 机器人辅助腹腔镜输尿管再植术治疗小儿梗阻性巨输尿管的疗效[J]. 中华泌尿外科杂志, 2019, 40(11):801-805. DOI:10.3760/cma.j.issn.1000-6702.2019.11.001. Cao HL, Zhou HX, Ma LF, et al. Efficacy of robot-assisted laparoscopic ureteral reimplantation for primary obstructive megaureter in children[J]. Chinese Journal of Urology, 2019, 40(11):801-805. DOI:10.3760/cma.j.issn.1000-6702.2019.11.001.
11 Brown CT, Sebasti?o YV, McLeod DJ.et al. Trends in surgical management of multicystic dysplastic kidney at USA children’s hospitals[J]. J Pediatr Urol, 2019, 15(4):368-373. DOI:10.1016/j.jpurol.2019.04.024.
12 Bansal D, Cost NG, Bean CM, et al. Comparison of Pediatric robotic-assisted laparoscopic nephroureterectomy and laparoendoscopic single-site nephroureterectomy[J]. Urology, 2014, 83(2):438-442. DOI:10.1016/j.urology.2013.08.066.
13 Neheman A, Kord E, Strine AC, et al. Pediatric partial nephrectomy for upper urinary tract duplication anomalies:a comparison between different surgical approaches and techniques[J]. Urology, 2019, 125:196-201. DOI:10.1016/j.urology.2018.11.026.
14 Meininger DD, Byhahn C, Heller K, et al. Totally endoscopic Nissen fundoplication with a robot system in a child[J]. Surgical Endoscopy, 2001, 15(11):1360. DOI:10.1007/s001010051001.
15 Hambraeus M, Arnbj Rnsson E, Anderberg M.A literature review of the outcomes after robot-assisted laparoscopic and conventional laparoscopic Nissen fundoplication for gastro-esophageal reflux disease in children[J]. Int J Med Robot, 2013, 9(4):428-432. DOI:10.1002/rcs.1517.
16 黄格元, 蓝传亮, 刘雪来, 等. 达芬奇机器人在小儿外科手术中的应用(附20例报告)[J]. 中国微创外科杂志, 2013, 13(1):4-8. DOI:10.3969/j.issn.1009-6604.2013.01.002. Huang GY, Lan CL, Liu XL, et al. Da Vinci Robotic system for pediatric surgery:a report of 20 cases[J]. Chinese Journal of Minimally Invasive Surgery, 2013, 13(1):4-8. DOI:10.3969/j.issn.1009-6604.2013.01.002.
17 Chaussy Y, Becmeur F, Lardy H, et al. Robot-assisted surgery:current status evaluation in abdominal and urological pediatric surgery[J]. J Laparoendosc Adv Surg Tech A, 2013, 23(6):530-538. DOI:10.1089/lap.2012.0192.
18 Margaron FC, Oiticica C, Lanning DA.Robotic-assisted laparoscopic Nissen fundoplication with gastrostomy preservation in neurologically impaired children[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(5):489-492. DOI:10.1089/lap.2009.0367.
19 Anvari M, Allen C.Laparoscopic Nissen fundoplication:two-year comprehensive follow-up of a technique of minimal paraesophageal dissection[J]. Annals of Surgery, 1998, 227(1):25. DOI:10.1097/00000658-199801000-00004.
20 Woo R, Le D, Albanese CT, et al. Robot-assisted laparoscopic resection of a type I choledochal cyst in a child[J]. J Laparoendosc Adv Surg Tech A, 2006, 16(2):179-183. DOI:10.1089/lap.2006.16.179.
21 Chang EY, Hong YJ, Chang HK, et al. Lessons and tips from the experience of pediatric robotic choledochal cyst resection[J]. J Laparoendosc Adv Surg Tech A, 2012, 22(6):609-614. DOI:10.1089/lap.2011.0503.
22 Alizai NK, Dawrant MJ, Najmaldin AS.Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children[J]. Pediatr Surg Int, 2014, 30(3):291-294. DOI:10.1007/s00383-013-3459-5.
23 Kim NY, Chang EY, Hong YJ, et al. Retrospective assessment of the validity of robotic surgery in comparison to open surgery for pediatric choledochal cyst[J]. Yonsei Med J, 2015, 56(3):737-743. DOI:10.3349/ymj.2015.56.3.737.
24 Meehan JJ, Elliott S, Sandler A.The robotic approach to complex hepatobiliary anomalies in children:preliminary report[J]. Journal of Pediatric Surgery, 2007, 42(12):2110-2114. DOI:10.1016/j.jpedsurg.2007.08.040.
25 Dutta S, Woo R, Albanese CT.Minimal access portoenterostomy:advantages and disadvantages of standard laparoscopic and robotic techniques[J]. J Laparoendosc Adv Surg Tech A, 2007, 17(2):258-264. DOI:10.1089/lap.2006.0112.
26 Chen D, Wang S, Jiang Y, et al. Robot-assisted gallbladder-preserving hepatectomy for treating S5 hepatoblastoma in a child:A case report and review of the literature[J]. World Journal of Clinical Cases, 2019, 7(7):872-880. DOI:10.12998/wjcc.v7.i7.872.
27 Hebra A, Smith VA, Lesher AP.Robotic Swenson pull-through for Hirschsprung’s disease in infants[J]. Am Surg, 2011, 77(7):937-941.
28 Mattioli G, Pio L, Leonelli L, et al. A Provisional experience with robot-assisted soave procedure for older children with Hirschsprung disease:back to the future?[J]. J Laparoendosc Adv Surg Tech A, 2017, 27(5):546-549. DOI:10.1089/lap.2016.0337.
29 Pini Prato A, Arnoldi R, Dusio MP, et al. Totally robotic soave pull-through procedure for Hirschsprung’s disease:lessons learned from 11 consecutive pediatric patients[J]. Pediatric Surgery International, 2020, 36(2):209-218. DOI:10.1007/s00383-019-04593-z.
30 Alqahtani A, Albassam A, Zamakhshary M, et al. Robot-assisted pediatric surgery:how far can we go?[J]. World Journal of Surgery, 2010, 34(5):975-978. DOI:10.1007/s00268-010-0431-6.
31 Rothenberg SS.Experience with thoracoscopic lobectomy in infants and children[J]. J Pediatr Surg, 2003, 38(1):102-104. DOI:10.1089/lap.2009.0093.
32 Durand M, Musleh L, Vatta F, et al. Robotic lobectomy in children with severe bronchiectasis:A worthwhile new technology[J]. J Pediatr Surg, 2020, S0022-3468(20)30838-1. DOI:10.1016/j.jpedsurg.2020.11.009.
33 Navarrete Arellano M, Garibay González F.Robot-assisted laparoscopic and thoracoscopic surgery:prospective series of 186 pediatric surgeries[J]. Front Pediatr, 2019, 7:200. DOI:10.3389/fped.2019.00200.
34 李帅, 汤绍涛, 曹国庆, 等. da Vinci机器人辅助胸腔镜下小儿肺叶切除术的初步经验[J]. 临床小儿外科杂志, 2020, 19(7):619-621, 647. DOI:10.3969/j.issn.1671-6353.2020.07.011. Li S, Tang ST, Cao GQ, et al. Preliminary experience of thoracoscopic pulmonary lobectomy using da Vinci robotic system in children[J]. J Clin Ped Sur, 2020, 19(7):619-621, 647. DOI:10.3969/j.issn.1671-6353.2020.07.011.
35 Le Bret E, Papadatos S, Folliguet T, et al. Interruption of patent ductus arteriosus in children:Robotically assisted versus videothoracoscopic surgery[J]. J Thorac Cardiovasc Surg, 2002, 123(5):973-976. DOI:10.1067/mtc.2002.121049.
36 Suematsu Y, Mora BN, Mihaljevic T, et al. Totally endoscopic robotic-assisted repair of patent ductus arteriosus and vascular ring in children[J]. Ann Thorac Surg, 2005, 80(6):2309-2313. DOI:10.1016/j.athoracsur.2005.05.078.
37 Hollands CM, Dixey LN.Robotic-assisted esophagoesophagostomy[J]. J Pediatr Surg, 2002, 37(7):983-985. DOI:10.1053/jpsu.2002.33823.
38 Lorincz A, Langenburg S, Klein MD.Robotics and the pediatric surgeon[J]. Current Opinion in Pediatrics, 2003, 15(3):262-266. DOI:10.1097/00008480-200306000-00006.
39 Lorincz A, Langenburg SE, Knight CG, et al. Robotically assisted esophago-esophagostomy in newborn pigs[J]. J Pediatr Surg, 2004, 39(9):1386-1389. DOI:10.1016/j.jpedsurg.2004.05.015.
40 Ballouhey Q, Villemagne T, Cros J, et al. Assessment of paediatric thoracic robotic surgery[J]. Interact Cardiovasc Thorac Surg, 2015, 20(3):300-303. DOI:10.1093/icvts/ivu406.
41 曹国庆, 张茜, 周莹, 等. 机器人胸腔镜手术治疗食管闭锁:国内首例报告[J]. 中国微创外科杂志, 2020, 20(11):1026-1028. DOI:10.3969/j.issn.1009-6604.2020.11.016. Cao GQ, Zhang Q, Zhou Y, etal.Robotic surgery for esophageal atresia:the first case in China[J]. Chinese Journal of Minimally Invasive Surgery, 2020, 20(11):1026-1028. DOI:10.3969/j.issn.1009-6604.2020.11.016.
42 Pham HD, Okata Y, Vu HM, et al. Robotic-assisted surgery for choledochal cyst in children:early experience at Vietnam National Children’s Hospital[J]. Pediatric Surgery International, 2019, 35(11):1211-1216. DOI:10.1007/s00383-019-04518-w.
43 Chi S, Cao G, Li S, et al. Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children[J]. Surg Endosc, 2020. DOI:10.1007/s00464-020-07981-y.
44 Nazki S, Kanojia RP, Bawa M, et al. Robotic excision of choledochal cyst with hepaticoduodenostomy (HD):report of HD technique, initial experience, and early outcome[J]. Eur J Pediatr Surg, 2021, 31(3):286-291. DOI:10.1055/s-0040-1713933.
45 Koga H, Murakami H, Ochi T, et al. Comparison of robotic versus laparoscopic hepaticojejunostomy for choledochal cyst in children:a first report[J]. Pediatric Surgery International, 2019, 35(12):1421-1425. DOI:10.1007/s00383-019-04565-3.
46 Xie X, Li K, Wang J, et al. Comparison of pediatric choledochal cyst excisions with open procedures, laparoscopic procedures and robot-assisted procedures:a retrospective study[J]. Surgical Endoscopy, 2020, 34(7):3223-3231. DOI:10.1007/s00464-020-07560-1.
47 Xie X, Li Y, Li K, et al. Total robot-assisted choledochal cyst excision using da Vinci surgical system in pediatrics:Report of 10 cases[J]. J Pediatr Surg, 2021, 56(3):553-558. DOI:10.1016/j.jpedsurg.2020.07.019.
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备注/Memo
收稿日期:2021-04-10。
基金项目:浙江省腹腔脏器微创诊治临床医学研究(编号:01492-02)
通讯作者:舒强,Email:shuqiang@zju.edu.cn