随着腔镜技术不断发展和妇科医生腔镜手术技能的不断提高，妇科手术越来越微创化，使得以前必须开腹的手术而现在腹腔镜下就能达到同样的治疗效果，甚至由于腹腔镜的优势，该手术效果会更好。随着腹腔镜技术不断发展，腹腔镜手术变得越来越微创化，由传统的腹腔镜逐步发展到单孔腹腔镜（Laparoendoscopic singlesite，LESS），再发展到经自然腔道腹腔镜手术（Natural orifice transumbilical endoscopic surgery，NOTES）。妇科常用的手术是经阴道自然腔道腹腔镜手术（Transvaginal natural orifice transumbilical endoscopic surgery，vNOTES），医疗技术的每一次进步总是建立在良好的手术效果之上，需要妇科医生更高的手术技能。近年来，机器人技术已广泛应用于妇科腹腔镜手术，其优点包括：高清 3D 手术视野，机械臂及手腕更加灵活、稳定、精准，操作更舒适，可以进行远程手术。本文对妇科传统单孔腹腔镜手术（Laparoendoscopic single-site，LESS）和机器人辅助单孔腹腔镜手术（Robot-assisted laparoendoscopic single-site，R-LESS）的研究进行综述，从而为妇科医生在临床工作中选择合适的手术方式提供参考。

With the development of endoscopic technology and improvement of surgery skills of gynecologists, gynecological surgeries are becoming more and more minimally invasive. Laparoendoscopic surgery can achieve the same effect as laparotomy, or even better due to its advantages over laparotomy. From conventional laparoscopic surgery to laparoendoscopic single-site surgery (LESS), and to natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic surgery is becoming more and more minimally invasive with technology development. In recent years, robotic surgery system has been widely used in gynecology. With 3D high-definition view, more flexible, stable and precise arms, it has achieved good surgical results in gynecology. The surgeon can even perform surgeries by sitting beside the console, which can greatly relieve fatigue and ensure surgical safety, and telesurgery can be realized. This review aims to provide references for gynecologists by analyzing the advantages and disadvantages of robot-assisted and conventional laparoendoscopic single-site surgery in gynecology.

收稿日期：2020-12-28  录用日期：2021-03-02

Received Date: 2020-12-28  Accepted Date: 2021-03-02

基金项目：青海卫健委 2018 年基础研究指导项目（2018-wjzdx-24）

Foundation Item: Foundation Research Project of Qinghai Health Commission(2018-wjzdx-24)

通讯作者：伍东月，Email：wudongyue67@126.com

Corresponding Author: Wu Dongyue, Email: wudongyue67@126.com

引用格式：李子刚，伍东月 . 机器人辅助与传统单孔腹腔镜手术在妇科领域的应用 [J]. 机器人外科学杂志（中英文），2021，2（5）：347-355.

Citation: LI Z G, WU D Y. Application of robot-assisted and conventional laparoendoscopic single-site surgery in gynecology[J]. Chinese Journal of Robotic Surgery,  2021, 2(5): 347-355.

[1] GUAN Z, LIU J, Blazek K, et al. Robotic single-site tubal reanastomosis: the robotic factor[J]. J Minim Invasive Gynecol, 2018, 26(4): 607.

[2] Gargiulo A R, Choussein S, Srouji S S, et al. Coaxial robot-assisted laparoendoscopic single-site myomectomy[J]. J Robot Surg, 2017, 11(1): 27-35.

[3] Gungor M, Kahraman K, Ozbasli E, et al. Ovarian cystectomy for a dermoid cyst with the new single-port robotic system [J]. Minim Invasive Ther Allied Technol, 2015, 24(2): 123-126.

[4] Paek J, Lee J, Kong T W, et al. Robotic single-site versus laparoendoscopic single-site hysterectomy: a propensity score matching study[J]. Surg Endosc, 2016, 30(3): 1043-1050.

[5] LIU Z, TIAN S, YAN Z, et al. Robotic single-site surgery for mature cyst teratoma cystectomy: an initial case series study in a single medical center in China[J]. Ther Clin Risk Manag, 2019. DOI: 10.2147/TCRM. S176852.

[6] 顾成磊 , 范文生 , 杨雯 , 等 . 机器人单孔腹腔镜妇科手术 11 例临床观察 [J].中华腔镜外科杂志 ( 电 子版 ), 2018, 11(4): 212-215．

[7] Song T, Kim T J, Lee S H, et al. Laparoendoscopic single-site myomectomy compared with conventional laparoscopic myomectomy: a multicenter, randomized, controlled trial[J]. Fertil Steril, 2015, 104(5): 1325- 1331.

[8] Choi E J, Rho A M, Lee S R, et al. Robotic singlesite myomectomy: clinical analysis of 61 consecutive cases[J]. J Minim Invasive Gynecol, 2017, 24(4): 632- 639．

[9] Gargiulo A R, Feltmate C, Srouji S S. Robotic singlesite excision of ovarian endometrioma[J]. Fertil Res Pract, 2015.DOI: 10.1186/s40738-015-0011-4.

[10] Kim M, Kim M K, Kim M L, et al. Robotic singlesite myomectomy: a single-center experience of 101 consecutive cases[J]. Int J Med Robot, 2019, 15(1): e1959.

[11] Moawad G N, Tyan P, Paek J, et al. Comparison between single-site and multiport robot-assisted myomectomy [J]. J Robot Surg, 2019, 13(6): 757-764.

[12] Escobar P F, Fader A N, Paraiso M F, et al. Roboticassisted laparoendoscopic single-site surgery in gynecology: initial report and technique[J]. J Minim◆Invasive Gynecol, 2009, 16(5): 589-591.

[13] Sendag F, Akdemir A, Zeybek B, et al. Single-site robotic total hysterectomy: standardization of technique and surgical outcomes[J]. J Minim Invasive Gynecol, 2014, 21(4): 689-694.

[14] Gomes M, Machado A, Podgaec S, et al. Initial experience with single-port robotic hysterectomy[J]. Einstein (SaoPaulo), 2017, 15(4): 476-480.

[15] Bogliolo S, Ferrero S, Cassani C, et al. Single-site versus multiport robotic hysterectomy in benign gynecologic diseases: a retrospective evaluation of surgical outcomes and cost analysis[J]. J Minim Invasive Gynecol, 2016, 23(4): 603-609.

[16] Paek J, Lee J D, Kong T W, et al. Robotic single-site versus laparo-endoscopic single-site surgery for adnexal tumours: a propensity score-matching analysis[J]. Int J Med Robot, 2016, 12(4): 694-700.

[17] Lopez S, Mulla Z D, Hernandez L, et al. A comparison of outcomes between robotic-assisted, single-site laparoscopy versus laparoendoscopic single site for benign hysterectomy [J]. J Minim Invasive Gynecol, 2016, 23(1): 84-88.

[18] Scheib S A. A laparoendoscopic single-site surgical approach to laparoscopic salpingectomy[J]. J Minim Invasive Gynecol, 2018, 25(2): 326-327.

[19] GUAN X, Walsh T M, Hernandez A, et al. Robotic single-incision ovarian vein ligation for pelvic congestion syndrome[M]. Las Vegas: 44th AAGL Global Congress on Minimally Invasive Gynecology, 2015.

[20] Moon H S, Shim J E, Lee S R, et al. The comparison of robotic single-site surgery to single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis [J]. J Laparoendosc Adv Surg Tech A, 2018, 28 (12): 1483-1488.

[21] 刘晓军 , 高京海 , 刘洋 , 等 . 第三代 da Vinci Si 机器 人手术系统在妇科单孔腹腔镜手术中的初步应用 [J]. 第二军医大学学报 , 2018. DOI: 10.16781/j.0258- 879x.2021.05.0573.

[22] Nezhat C H, Nezhat F, Nezhat C. Laparoscopic sacral colpopexy for vaginal vault prolapse[J]. Obstet Gynecol, 1994, 84(5): 885-888.

[23] Lee S R. Robotic single-site or sacroccolpopexy: first report and technique using the single-site or wristed needle driver[J]. Yansei Med J, 2016, 57(4): 1029- 1033.

[24] Hemmings R, Rivard M, Olive D L, et al. Evaluation of risk factors associated with endometriosis[J]. Fertil Steril, 2004, 81(6): 1513-1521.

[25] Lowenstein L, Matanes E, Burke Y Z. Surgical technique for robot-assisted sacrocolpopexy performed via a single port[J]. Urology, 2017.DOI: 10.1016/ j.urology.2016.11.023.

[26] GUAN X, MA Y, Gisseman J, et al. Robotic singlesite sacrocolpopexy using barbed suture anchoring and peritoneal tunneling technique: tips and tricks[J]. J Minim Invasive Gynecol, 2017, 24(1): 12-13.

[27] Matanes E, Lauterbach R, Mustafa-Mikhail S, et al. Single port robotic assisted sacrocolpopexy: our experience with the first 25 cases[J]. Female Pelvic Med Reconstr Surg, 2017, 23(3): e14-e18.

[28] Davila H H, Gallo T, Bruce L, et al. Robotic and laparoendoscopic single-site utero-sacral ligament suspension for apical vaginal prolapse: evaluation of our technique and perioperative outcomes[J]. J Robot Surg, 2017, 11(2): 171-177.

[29] Fader A N, Escobar P F. Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report[J]. Gynecol Oncol, 2009, 114(2): 157-161.

[30] Yoo J G, Kim W J, Lee K H. Single-site robot-assisted laparoscopic staging surgery for presumed clinically early-stage ovarian cancer[J]. J Minim Invasive Gynecol, 2018, 25(3): 380-381.

[31] Melamed A, Margul D J, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer[J]. N Engl J Med, 2018, 379(20): 1905-1914.

[32] Ramirez P T, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer[J]. N Engl J Med, 2018, 379(20): 1895- 1904.

[33] Sert B, Abeler V. Robotic radical hysterectomy in earlystage cervical carcinoma patients, comparing results with total laparoscopic radical hysterectomy cases.The future is now?[J]. Int J Med Robot Comp, 2007, 3(3): 224-228.

[34] Vizza E, Chiofalo B, Cutillo G, et al. Robotic single site radical hysterectomy plus pelvic lymphadenectomy in gynecollgical cancers[J]. J Gynecol Oncol, 2018, 29(1): e2.

[35] Sinno A K, Tanner E J. Robotic laparoendoscopic single site radical hysterectomy with sentinel lymph node mapping and pelvic lymphadenectomy for cervical cancer[J]. J Minim Invasive Gynecol, 2015, 22(6S): S115.

[36] Moukarzel L A, Sinno A K, Fader A N, et al. Comparing single-site and multiport robotic hysterectomy with sentinel lymph node mapping for endometrial cancer: surgical outcomes and cost analysis[J]. J Minim Invasive Gynecol, 2017, 24(6): 977-983.

[37] Corrado G, Mereu L, Bogliolo S, et al. Robotic single site staging in endometrial cancer: a multi-institution study[J]. Eur J Surg Oncol, 2016, 42(10): 1506-1511.

[38] Corrado G, Calagna G, Cutillo G, et al. The patient and observer scar assessment scale to evaluate the cosmetic outcomes of the robotic single-site hysterectomy in endometrial cancer[J]. Int J Gynecol Cancer, 2018, 28(1): 194-199.

[39] Fagotti A, Corrado G, Fanfani F, et al. Robotic singlesite hysterectomy(RSS-H) vs laparoendoscopic singlesite hysterectomy(LESS-H) in early endometrial cancer: a double-institution case-control study[J]. Gynecol Oncol, 2013, 130(1): 219-223.