機器人系統簡化子宮切除術後的陰道穹窿脫垂手術


  Feb. 24, 2004 - 根據刊載於2月份泌尿學科期刊的一項研究結果顯示,機器人輔助腹腔內試鏡髂雌骨陰道固定術,可減少子宮切除術後的陰道穹窿脫垂症狀治療的發病率及降低住院天數。
  
  明尼蘇達州羅契斯特市Mayo 診所David S. DiMarco博士和其同僚表示,利用機器人系統輔助腹腔內試鏡髂雌骨陰道固定術可增加體內縫合定位,讓此手術結果媲美開放式手術。
  
  他們強調,利用機器人系統輔助腹腔內試鏡髂雌骨陰道固定術的優點為,貫穿腹部的技術及修補的外科原理皆可在非侵入式的方法下模擬進行,且可避免由腹部中間剖開。
  
  研究員對五位女性執行此手術,其中3位患者曾因應力性尿失禁執行陰道恥骨吊帶定位手術,所有患者中有2位患者有3級頂部陰道穹窿脫垂症狀,另3位患者有4級陰道穹窿脫垂症狀。除此之外,3位患者有2至4級不等之前壁脫垂現象,而沒有任何患者在手術前有後壁脫垂現象。
  
  外科醫師僱用機器人daVinci,其為一完整的電腦系統為基礎所組成之兩個可相互作用的機器手臂,一個攝影機手臂和一個具3度電視圖像能力之遙控器,機器人以類似人類腕關節般之6級自由度操作儀器,機器人手臂附有可重複使用之套管針和研究員透過一支標準的12mm內試鏡放置的照相機。
  
  患者被安置如背側膀胱切石術的位置,外科醫師放置一支攝影機、兩支機器手臂和兩支標準腹腔內試鏡。利用腹腔鏡,他們裝置一可回縮式的縫線透過S形的軟組織縫帶穿過腹腔壁,此處理藉著Trendelenburg位置幫助薦骨隆突、陰道及膀胱暴露出來。
  
  接上機器人daVinci後,外科醫師即利用它縫合一Y形移植片於陰道至薦骨隆突的位置,他們在執行culdoplasty手術時將子宮薦骨韌帶打褶,然後關閉後腔壁腹膜後蓋膜移植片。
  
  外科醫師於24小時後讓5位婦女離開,1位患者在手術後兩天有頑固性出血,此為陰道恥骨吊帶定位手術的副作用。平均追蹤期為4個月。
  
  剖開手術的發生率大大降低,住院日亦減少,從剖開手術的5至6日減少為使用內試鏡修補後1天的住院日。DiMarco醫師和其同僚強調,此手術亦開始展現出與剖開術一樣的耐久性,許多婦女可被建議以此最好的修補方法治療脫垂症狀,同時維持最低的發病率。

Robotic System Simplifies Post

By Mindy Hung
Medscape Medical News

Feb. 24, 2004 — Robotic-assisted laparoscopic sacrocolpopexy may minimize morbidity for the treatment of posthysterectomy vaginal vault prolapse and reduce hospital stay, according to the results of a study published in the February issue of Urology.

"Using a robotic system for laparoscopic sacrocolpopexy facilitated precise intracorporeal suture placement so that the procedure could be done in a fashion similar to that of the open method," write David S. DiMarco, MD, and colleagues from the Mayo Clinic in Rochester, Minnesota.

"The advantage of using a robotic system for laparoscopic sacrocolpopexy is that the open transabdominal technique and surgical principles of repair can be mimicked in a noninvasive fashion while avoiding a midline abdominal incision," they add.

Investigators performed the procedure on five women, three with concomitant pubovaginal sling placement for stress urinary incontinence. Two women had grade 3 apical prolapse (vaginal vault) and three women had grade 4. In addition, three women had anterior prolapse ranging from grade 2 to 4. None of the women had preoperative posterior prolapse.

The surgeons employed the daVinci robot, an integrated computer-based system consisting of two interactive robotic arms, a camera arm, and a remote control with three-dimensional vision capability. The robot uses instruments with six degrees of freedom, which provides the same flexibility as the human wrist. The robot's arms were attached to reusable 8-mm trocars, and investigators positioned the camera through a standard 12-mm laparoscopic port.

Patients were put in a dorsal lithotomy position. The surgeons placed one camera port, two robotic ports, and two standard laparoscopic ports transperitoneally. Using standard laparoscopy, they then placed a retracting suture through the sigmoid tenia and brought it out through the abdominal wall. This maneuver, along with a Trendelenburg position, helped improve exposure of the sacral promontory, vagina, and bladder.

After docking the daVinci robot, the surgeons used it to suture a silicone Y-shaped graft from the vagina to the sacral promontory. They performed culdoplasty, with plication of the uterosacral ligaments. They then closed the posterior peritoneum to retroperitonealize the graft.

The surgeons discharged all five women after 24 hours. One patient had persistent vaginal bleeding for two days postoperatively, a complication related to the pubovaginal sling portion of the case. Average follow-up was four months.

"The morbidity of the open procedure has been greatly reduced, and the hospital stay has been decreased from 5 to 6 days with the open procedure to 1 day with the laparoscopic repair. Also, it appears initially, that the durability of the repair will be the same as with the open procedure," write Dr. DiMarco and colleagues.

"Potentially, many more women will be able to be offered the strongest repair for prolapse while still keeping the morbidity to a minimum."

Urology. 2004;63:373-376

Reviewed by Gary D. Vogin, MD

    
相關報導
年輕病患子宮內膜燒灼術後有較高的子宮切除風險
2008/12/30 下午 05:23:00
子宮切除術後進行壓力型尿失禁手術的風險可能增加一倍
2007/11/2 上午 11:00:00
自我覺察法對尿失禁婦女有效
2007/5/23 下午 03:15:00

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁