胃癌是全球最常见的消化道恶性肿瘤之一,其发病率和死亡率均位居前列。机器人手术作为前沿技术,凭借技术优势、 操作优势、卫生经济学优势及学习曲线优势在胃癌的微创手术治疗中显示出其独特的价值。机器人手术系统存在的触觉反馈 缺失、购置和维护费用高昂、远期疗效及并发症发生率缺乏高质量的临床证据等缺陷是其在临床上进一步推广的阻碍,但随 着持续的技术创新与深入的临床研究,上述局限性均有望得到解决。未来机器人手术将朝着远程化、自动化、集成化的方向 发展,在医疗过程中造福更多患者。
Gastric cancer, with high morbidity and mortality, is one of the most common malignant tumors of the gastrointestinal tract worldwide. As a cutting-edge technology, robotic surgery shows its unique value in minimally invasive surgical treatment of gastric cancer by virtue of its technological advantages, operational advantages, health economics advantages, and learning curve advantages. However, the lack of haptic feedback, high acquisition and maintenance costs, insufficient high-quality clinical evidence of complication rates and long-term efficacy have hampered the further clinical dissemination of robotic surgical systems, but those current limitations could be expected to resolve with continued technological innovation and in-depth clinical remote control. In the future, robotic surgery will develop in the direction of remote control, automation, and integration to benefit patients in the medical industry.
基金项目:江苏省中医药科技发展重点项目(ZD201903);江苏省重点学科项目(ZDXK202251)
Foundation Item: Jiangsu Provincical Key Program for Scientific and Technological Development of Chinese Medicine (ZD201903); Key Discipline Program of Jiangsu Provincial (ZDXK202251)
引用格式:徐鹏演,王刚,江志伟 . 机器人辅助胃癌根治术的优势及局限性 [J]. 机器人外科学杂志(中英文). 2025,6(2):340-344.
Citation: XU P Y, WANG G, JIANG Z W. Advantages and limitations of robot-assisted radical gastrectomy[J]. Chinese Journal of Robotic Surgery, 2025, 6(2): 340-344.
通讯作者(Corresponding Author):江志伟(JIANG Zhiwei),Email:surgery34@163. com
[1] Sung H, Ferlay J, Siegel R L, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] LOU S H, YIN X, WANG Y F, et al. Laparoscopic versus open gastrectomy for gastric cancer: A systematic review and meta-analysis of randomized controlled trials[J]. Int J Surg, 2022, 102: 106678.
[3] Guerrini G P, Esposito G, Magistri P, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: The largest meta-analysis[J]. Int J Surg, 2020, 82: 210-228.
[4] 余佩武 , 李政焰 . 中国胃癌机器人手术开展的现状与思考 [J]. 中华胃 肠外科杂志 , 2020, 23(04): 332-335.
[5] Farinha R, Puliatti S, Mazzone E, et al. Potential contenders for the leadership in robotic surgery[J]. Journal of Endourology, 2022, 36(3): 317-326.
[6] 曹鹏 , 王国慧 , 易波 , 等 . 国产手术机器人的发展现状与未来方向 [J]. 结直肠肛门外科 , 2024, 30(3): 249-252, 258.
[7] Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system[J]. Surgical Endoscopy, 2002, 16(8): 1187-1191.
[8] 余佩武 , 钱锋 , 曾冬竹 , 等 . 达芬奇机器人手术系统胃癌根治术五例 报告 [J]. 中华外科杂志 , 2010, 48(20): 1592-1594.
[9] 江志伟 , 黎介寿 , 李宁 . 腹腔镜与机器人手术上消化道重建合理吻合 方式 [J]. 中国实用外科杂志 , 2012, 32(8): 637-639.
[10] DAI H B, WANG Z C, FENG X B, et al. Case report about a successful full robotic radical gastric cancer surgery with intracorporeal robot-sewn anastomosis in a patient with situs inversus totalis and a two-and-a-halfyear follow-up study[J]. Surg Endosc, 2018, 16(1): 1187-1191.
[11] 王国慧 , 易波 , 刘勇 , 等 . 国产手术机器人临床Ⅰ期研究 ( 附 103 例报 告 )[J]. 中国实用外科杂志 , 2019, 39(8): 840-843.
[12] 舒之群 , 屈佳璐 , 张淑贤 , 等 . 医疗机构在国产手术机器人“产学研 医”协同创新转化模式中角色的探讨 [J]. 中国医疗器械杂志 , 2023, 47(5): 582-586.
[13] Wong S W, Crowe P. Visualisation ergonomics and robotic surgery[J]. J Robot Surg, 2023, 17(5): 1873-1878.
[14] 张小磊 , 江志伟 , 王刚 , 等 . 机器人及腹腔镜胃癌根治术后胰瘘发生 的影响因素分析 [J]. 腹部外科 , 2022, 35(6): 408-412.
[15] Yang K, Cho M, Roh C K, et al. Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer[J]. Surgical Endoscopy, 2019, 33(7): 2357-2363.
[16] WANG G, JIANG Z W, ZHAO J, et al. Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: A randomized clinical trial[J]. Journal of Surgical Oncology, 2016, 113(4): 397-404.
[17] 刘江 , 王刚 , 冯啸波 , 等 . 完全机器人手工缝合消化道重建技术在 全胃切除术中的应用 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(3): 151-161.
[18] Browning K N, Travagli R A. Central nervous system control of gastrointestinal motility and secretion and modulation of gastrointestinal functions[J]. Comprehensive Physiology, 2014, 4(4): 1339-1368.
[19] 蔡林弟 , 樊林 . 早期胃癌手术保留迷走神经的争议 [J]. 中国实用外科 杂志 , 2022, 42(10): 1197-1200.
[20] 刘春阳 , 郝迎学 , 余佩武 , 等 . 达芬奇机器人手术系统保留迷走神经 胃癌根治术的临床疗效 [J]. 中华消化外科杂志 , 2017, 16(3): 251-256.
[21] 范义川 , 张驰 , 魏茂华 , 等 . 第 4 代达芬奇机器人手术系统辅助保留 幽门及迷走神经胃部分切除术治疗早期胃癌的临床疗效 [J]. 中华消 化外科杂志 , 2023, 22(08): 1014-1020.
[22] 中国残胃癌诊治协作组 . 中国残胃癌定义的外科专家共识意见(2018 年版)[J]. 中华胃肠外科杂志 , 2018, 21(5): 483-485.
[23] 蔡丽君 , 田素芳 . 残胃癌的诊疗研究进展 [J]. 武汉大学学报 ( 医学版 ), 2023, 44(1): 121-126.
[24] 钱锋 , 刘佳佳 , 刘军言 , 等 . 机器人在残胃上的癌手术治疗中的临床 应用 [J]. 中华胃肠外科杂志 , 2018, 21(5): 546-550.
[25] Shibasaki S, Suda K, Hisamori S, et al. Robotic gastrectomy for gastric cancer: systematic review and future directions[J]. Gastric Cancer, 2023, 26(3): 325-338.
[26] 张小春 , 沈丹丽 , 龚冠闻 , 等 . 江苏省某医院行机器人胃癌根治术的 卫生经济学研究 [J]. 中国医院统计 , 2023, 30(3): 198-202.
[27] FENG Q B, MA H X, QIU J, et al. Comparison of long-term and perioperative outcomes of robotic versus conventional laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis of PSM and RCT studies[J]. Frontiers in Oncology, 2021, 11: 759509.
[28] Chan K S, Oo A M. Establishing the learning curve of laparoscopic and robotic distal gastrectomy: a systematic review and meta-regression analysis[J]. J Gastrointest Surg, 2023, 27(12): 2946-2982.
[29] Chan K S, Oo A M. Learning curve of laparoscopic and robotic total gastrectomy: A systematic review and meta-analysis[J]. Surgery Today, 2023, 54(6): 509-522.
[30] 王刚 , 潘华峰 , 刘江 , 等 . 达芬奇 Xi 系统在完全机器人根治性远 端胃大部切除术中的应用 [J]. 山东大学学报 ( 医学版 ), 2020, 58(5): 51-55.
[31] Stephan D, Sälzer H, Willeke F. First experiences with the new Senhance® telerobotic system in visceral surgery[J]. Visceral Medicine, 2018, 34(1): 31-36.
[32] Chauhan M, Deshpande N, Pacchierotti C, et al. A robotic microsurgical forceps for transoral laser microsurgery[J]. International Journal of Computer Assisted Radiology and Surgery, 2019, 14(2): 321-333.
[33] LIAO G X, ZHAO Z H, Khan M, et al. Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients[J]. World Journal of Surgical Oncology, 2019, 17(1): 86-94.
[34] 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.
[35] LI Z Y, ZHOU Y B, LIT Y, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a multicenter cohort study of 5402 patients in china[J]. Ann Surg, 2023, 277(1): e87-e95.
[36] 张珂诚 , 曹博 , 卫勃 , 等 . 机器人与腹腔镜辅助胃癌根治术中复杂部 位淋巴结清扫对比研究 [J]. 中国肿瘤临床 , 2019, 46(11): 546-550.
[37] 顾成磊 , 李立安 , 王宁 , 等 . 5G 远程机器人辅助腹腔镜全子宫切除 术首例报道 [J]. 中国微创外科杂志 , 2023, 23(8): 610-615.
[38] YANG X C, WANG Y H, JIAO W, et al. Application of 5G technology to conduct tele-surgical robot-assisted laparoscopic radical cystectomy[J]. Int J Med Robot, 2022, 18(4): e2412.
[39] 赵斌 , 李金奇 , 赵春鹏 , 等 . 基于 5G 技术的骨科机器人远程导航辅 助植入经皮骨盆通道螺钉固定骨盆及髋臼骨折 [J]. 中国修复重建外 科杂志 , 2022, 36(8): 923-928.
[40] 郭靖 , 吴迪 , 成卓奇 , 等 . 机器人辅助手术自主性技术的进展 [J]. 机 器人外科学杂志 ( 中英文 ), 2023, 4(4): 281-298.
[41] Ray K. Autonomous robotic laparoscopic gastrointestinal surgery[J]. Nat Rev Gastroenterol Hepatol, 2022, 19(3): 148-148.
[42] Saeidi H, Opfermann J D, Kam M, et al. Autonomous robotic laparoscopic surgery for intestinal anastomosis[J]. Sci Robot, 2022, 7(62): eabj2908.
[43] Thai M T, Phan P T, Hoang T T, et al. Advanced intelligent systems for surgical robotics[J]. Advanced Intelligent Systems, 2020, 2(8): 1900138.
[44] Rehan M, Saleem M M, Tiwana M I, et al. A soft multi-axis high force range magnetic tactile sensor for force feedback in robotic surgical systems[J]. Sensors (Basel), 2022, 22(9): 3500.
[45] Diana P, Buffi N M, Lughezzani G, et al. The role of intraoperative indocyanine green in robot-assisted partial nephrectomy: results from a large, multi-institutional series[J]. Eur Urol, 2020, 78(5): 743-749.
[46] 马伟佳 , 朱小龙 , 刘青瑶 , 等 . 人工智能在机器人辅助手术中的应 用 [J]. 机械工程学报 , 2024, 60(17): 22-39.