机器人手术系统目前已广泛地应用于各种妇科疾病的微创手术中。达芬奇手术机器人具有合理的人体工学设计、灵活移动的机械臂和腕式手术器械，可自主控制三维高清视野，在许多外科微创手术治疗中具有明显的优势。但是达芬奇手术机器人费用高昂，医用成本相对较高。本文对机器人手术系统在妇科疾病的适应证、优势进行回顾分析，并对机器人手术系统在未来的应用进行展望，旨在对妇科微创手术提供一定的指导建议。

The Da Vinci robot surgical system has been widely applied in minimally invasive surgery of gynecology. The system is equipped with ergonomically designed console, 3D vision in surgical field and wristed instruments, which could ensure surgeons to perform operations freely through the masters and foot pedals, it shows significant advantages in many minimally invasive surgeries of gynecology. However, Da Vinci robot is much expensive and the surgical costs is so high. The indications and advantages of Da Vinci surgical system in gynecology were retrospectively analyzed and its future applications were discussed in this paper, hopefully to provide some suggestions to surgeons in minimally invasive surgery of gynecology.

收稿日期：2020-12-22  录用日期：2021-03-19

Received Date: 2020-12-22  Accepted Date: 2021-03-19

通讯作者：王育，Email：renjiwangyu@126.com

Corresponding Author: WANG Yu, Email: renjiwangyu@126. com

引用格式：汪超，王育 . 手术机器人在妇科疾病诊疗中的优势和前景展望 [J]. 机器人外科学杂志（中英文），2021，2（4）：313-323.

Citation: WANG C, WANG Y. Advantages and prospects of robotic surgery system in gynecology[J]. Chinese Journal of Robotic Surgery, 2021, 2(4):313-323.

[1] Cardenas-Goicoechea J, Adams S, Bhat S B, et al. Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center [J]. Gynecol Oncol, 2010, 117(2): 224-228.

[2] Gala R B, Margulies R, Steinberg A, et al. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy [J]. Journal of Minimally Invasive Gynecology, 2014, 21(3): 353-361.

[3] Heo Y J, Kim S, Min K J, et al. The comparison of surgical outcomes and learning curves of radical hysterectomy by laparoscopy and robotic system for cervical cancer: an experience of a single surgeon [J]. Obstet Gynecol Sci, 2018, 61(4): 468-476.

[4] 杨凡 , 王宇 , 李武平 , 等 . 达芬奇机器人手术配合流程再造及效果评价 [J]. 中华腔镜外科杂志 ( 电子 版 ), 2013, 6(5): 61-63.

[5] Mäenpää M M, Nieminen K, Tomás E I, et al. Roboticassisted versus traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial [J]. American Journal of Obstetrics and Gynecology, 2016, 215(5): 588. e1-588. e7.

[6] Collinet P, Leguevaque P, Neme R M, et al. Robotassisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study [J]. Surg Endosc, 2014, 28(8): 2474-2479.

[7] Morelli L, Perutelli A, Palmeri M, et al. Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes [J]. Int J Colorectal Dis, 2016, 31(3): 643-652.

[8] 王文莉 , 段华 . 多发巨大子宫肌瘤 4 例报告并文献复习 [J]. 北京医学 , 2018, 40(1): 82-83, 86.

[9] 帅瑜 , 纪妹 , 赵曌 , 等 . 达芬奇机器人系统用于子宫肌瘤剔除术的安全性及可行性 [J]. 中国实用医刊 , 2018, 45(11): 38-39, 42.

[10] Barakat E E, Bedaiwy M A, Zimberg S, et al. Roboticassisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes [J]. Obstetrics & Gynecology, 2011, 117(2): 256-266.

[11] Iavazzo C, Mamais I, Gkegkes I D. Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence [J]. Archives of Gynecology and Obstetrics, 2016, 294(1): 5-17.

[12] Roberge S, Chaillet N, Boutin A, et al. Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture [J]. Int J Gynaecol Obstet, 2011, 115(1): 5-10.

[13] Gupta P, Ehlert M, Bartley J, et al. Perioperative outcomes, complications, and efficacy of roboticassisted prolapse repair: a single institution study of 196 patients [J]. Female Pelvic Medicine & Reconstructive Surgery, 2018, 24(6): 408-411.

[14] Jong K, Klein T, Zimmern P E. Long-term outcomes of robotic mesh sacrocolpopexy [J]. Journal of Robotic Surgery, 2018, 12(3): 455-460.

[15] LI X, ZHOU N, YANG Y, et al. Preliminary study on clinical application of robotic sacral hysteropexy in treatment of uterine prolapse [J]. Zhonghua Fu Chan Ke Za Zhi, 2014, 49(6): 428-431.

[16] Anand M, Weaver A L, Fruth K M, et al. Symptom relief and retreatment after vaginal, open, or robotic surgery for apical vaginal prolapse [J]. Female Pelvic Med Reconstr Surg, 2017, 23(5): 297-309.

[17] PAN K, ZHANG Y, WANG Y, et al. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy [J]. Int J Gynaecol Obstet, 2016, 132(3): 284-291.

[18] 孟元光 , 翟青枝 . 达芬奇机器人系统在妇科领域的应用进展及展望 [J]. 妇产与遗传 ( 电子版 ), 2019, 9(2): 10-13 .

[19] Turunen H, Pakarinen P, Sjöberg J, et al. Laparoscopic vs robotic-assisted surgery for endometrial carcinoma in a centre with long laparoscopic experience [J]. Journal of Obstetrics and Gynaecology, 2013, 33(7): 720-724.

[20] Seamon L G, Cohn D E, Henretta M S, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? [J]. Gynecologic Oncology, 2009, 113(1): 36-41.

[21] Subramaniam A, Kim K H, Bryant S A, et al. A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma [J]. Gynecologic Oncology, 2011, 122(3): 604-607.

[22] Mäenpää M M, Nieminen K, Tomás E I, et al. Robotic-assisted vs traditional laparoscopic surgery

for endometrial cancer: a randomized controlled trial [J]. American Journal of Obstetrics and Gynecology, 2016, 215(5): 588. e1-e7.

[23] Johansson C, Chan F. Robotic-assisted versus conventional laparoscopic hysterectomy for endometrial cancer [J]. Journal of Minimally Invasive Gynecology, 2019, 26(7): S74-S75.

[24] Gibbs J, Nandam J, Yassa M, et al. Impact of obesity on surgical and pathological outcomes in women with endometrial cancer undergoing robotic-assisted surgical staging [J]. International Journal of Advanced Research In Clinical Obstetrics And Gynaecology, 2018, 1(1): 1-4.

[25] Corrado G, Chiantera V, Fanfani F, et al. Robotic hysterectomy in severely obese patients with endometrial cancer: a multicenter study [J]. Journal of minimally invasive gynecology, 2016, 23(1): 94-100.

[26] Seamon L G, Bryant S A, Rheaume P S, et al. Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy [J]. Obstetrics & Gynecology, 2009, 114(1): 16-21.

[27] 王靖 , 姜蕾 , 郭天康 , 等 . 达芬奇机器人、腹腔镜及开腹子宫内膜癌全面分期手术的比较 [J]. 中国微创外科杂志 , 2018, 18(11): 974-977.

[28] 黄路遥 , 纪妹 , 赵曌 , 等 . 达芬奇机器人手术系统在子宫内膜癌全面分期手术中的应用价值 [J]. 河南外科学杂志 , 2019, 25(2): 19-21.

[29] James J A, Rakowski J A, Jeppson C N, et al. Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer [J]. Gynecologic oncology, 2015, 136(2): 285-292.

[30] Bodurtha Smith A J, Fader A N, Tanner E J. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis [J]. Am J Obstet Gynecol, 2017, 216(5): 459-476 e10.

[31] Rossi E C, Ivanova A, Boggess J F. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study [J]. Gynecol Oncol, 2012, 124(1): 78-82.

[32] Paley P J, Veljovich D S, Press J Z, et al. A prospective investigation of fluorescence imaging to detect sentinel◆lymph nodes at robotic-assisted endometrial cancer staging [J]. Am J Obstet Gynecol, 2016, 215(1): 117e1-7.

[33] Rossi E C, Jackson A, Ivanova A, et al. Detection of sentinel nodes for endometrial cancer with robotic assisted fluorescence imaging: cervical versus hysteroscopic injection [J]. Int J Gynecol Cancer, 2013, 23(9): 1704-1711.

[34] Kim T H, Choi C H, Choi J K, et al. Robotic versus laparoscopic radical hysterectomy in cervical cancer patients: a matched-case comparative study [J]. International Journal of Gynecologic Cancer, 2014, 24(8): 1466-1473.

[35] Park D, Yun J, Kim S, et al. Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: a systematic review and meta-analysis [J]. European Journal of Surgical Oncology (EJSO), 2017, 43(6): 994-1002.

[36] Shazly S A, Murad M H, Dowdy S C, et al. Robotic radical hysterectomy in early stage cervical cancer: a systematic review and meta-analysis [J]. Gynecologic oncology, 2015, 138(2): 457-471.

[37] Corrado G, Cutillo G, Saltari M, et al. Surgical and oncological outcome of robotic surgery compared with laparoscopic and abdominal surgery in the management of locally advanced cervical cancer after neoadjuvant chemotherapy [J]. International Journal of Gynecologic Cancer, 2016, 26(3): 539-546.

[38] Ramirez P T, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer [J]. New England Journal of Medicine, 2018, 379(20): 1895-1904.

[39] Kim S I, Cho J H, Seol A, et al. Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer [J]. Gynecologic oncology, 2019, 153(1): 3-12.

[40] Cusimano M C, Baxter N N, Gien L T, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer [J]. American Journal of Obstetrics and Gynecology, 2019, 221(6): 619. e1-e24.

[41] Brandt B, Sioulas V, Lavigne K, et al. Multicenter study of minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes [J]. Gynecologic Oncology, 2019, 154(1): 26.

[42] Uppal S, Gehrig P, Vetter M H, et al. Recurrence rates in cervical cancer patients treated with abdominal versus minimally invasive radical hysterectomy: A multi-institutional analysis of 700 cases [M]. American Society of Clinical Oncology, 2019, 37(15): 5504.

[43] CHEN C H, CHIU L H, CHEN H H, et al. Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer [J]. The International Journal of Medical Robotics and Computer Assisted Surgery, 2016, 12(2): 268-275.

[44] Magrina J F, Zanagnolo V, Noble B N, et al. Robotic approach for ovarian cancer: Perioperative and survival results and comparison with laparoscopy and laparotomy [J]. Gynecologic Oncology, 2011, 121(1): 100-105.

[45] Escobar P F, Levinson K L, Magrina J, et al. Feasibility and perioperative outcomes of robotic-assisted surgery in the management of recurrent ovarian cancer: a multiinstitutional study [J]. Gynecologic oncology, 2014, 134(2): 253-256.

[46] Coleman R L, Enserro D, Spirtos N, et al. A phase III randomized controlled trial of secondary surgical cytoreduction (SSC) followed by platinum-based combination chemotherapy (PBC), with or without bevacizumab (B) in platinum-sensitive, recurrent ovarian cancer (PSOC): a NRG oncology/gynecologic oncology group (GOG) study [J]. Journal of Clinical Oncology, 2018, 36(15): 5501.

[47] Jung Y W, Lee D W, Kim S W, et al. Robot-assisted staging using three robotic arms for endometrial cancer: comparison to laparoscopy and laparotomy at a single institution [J]. J Surg Oncol, 2010, 101(2): 116-121.

[48] RAN L, JIN J, XU Y, et al. Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis [J]. PLoS One, 2014, 9(9): e108361.

[49] Veljovich D S, Paley P J, Drescher C W, et al. Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging [J]. Am J Obstet Gynecol, 2008, 198(6): 679e1-679e9; discussion e9-e10.

[50] Boggess J F, Gehrig P A, Cantrell L, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy [J]. Am J Obstet Gynecol, 2008, 199(4): 360e1-360e9.

[51] Seamon L G, Cohn D E, Henretta M S, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: Robotics or laparoscopy? [J]. Gynecol Oncol, 2009, 113(1): 36-41.

[52] Boruta D M. Laparoendoscopic single-site surgery in gynecologic oncology: An update [J]. Gynecologic Oncology, 2016, 141(3): 616-623.

[53] 吕小慧 , 郭欣 , 李佳 , 等 . 机器人单孔腹腔镜在妇科手术中的初步应用探讨 [J]. 中华腔镜外科杂志( 电子版 ), 2019, 12(3): 154-158.

[54] 高京海 , 张育佼 , 金志军 , 等 . 机器人辅助单孔腹腔镜实施妇科恶性肿瘤手术技巧的探讨 [J]. 解放军医学杂志 , 2019, 44(7): 615-619.

[55] Marescaux J, Leroy J, Rubino F, et al. Transcontinental robot-assisted remote telesurgery: feasibility and potential applications [J]. Ann Surg, 2002, 235(4): 487- 492.

[56] 刘荣 , 赵国栋 , 孙玉宁 , 等 . 5G 远程机器人手术动 物实验研究 [J]. 中华腔镜外科杂志 ( 电子版 ), 2019, 12(1): 45-48.

[57] Butner S E, Ghodoussi M. Transforming a surgical robot for human telesurgery [J]. IEEE Trans Robotics and Automation, 2003, 19(5): 818-824.

[58] YANG Q, TANG J, XIAO L. Disease-free survival after robotic-assisted laparoscopic total pelvic exenteration for recurrent cervical adenocarcinoma: a case report [J]. Medicine (Baltimore), 2018, 97(30): e11611.