机器人直肠癌手术的现状及发展
Current status and development of robotic rectal cancer surgery
Received date: 2024-10-19
Online published: 2025-09-01
机器人手术系统凭借三维视图、可旋转器械及稳定镜头等优势，在直肠癌经腹与经肛手术中逐步应用。相比传统腹腔镜，机器人系统可降低全直肠系膜切除术（TME）难度，改善盆腔自主神经保护，且远期疗效与腹腔镜相当。然而，其高昂成本与有限临床效益引发反思，尤其在手术时间延长、缺乏力反馈及性价比不足等方面存在争议。研究表明，机器人手术可能在肥胖、骨盆狭窄及低位直肠癌等复杂病例中更具优势。国产手术机器人的快速发展有望打破市场垄断，降低成本，并通过远程医疗拓展应用场景。未来需进一步筛选明确获益人群，结合高质量循证医学证据优化机器人手术的临床应用。
徐世宁 综述 , 赵轩 , 杨晓 , 马君俊 审校 . 机器人直肠癌手术的现状及发展[J]. 外科理论与实践, 2025 , 30(03) : 272 -276 . DOI: 10.16139/j.1007-9610.2025.03.15
Robotic surgical systems, with advantages such as 3D visualization, rotating instruments, and stable imaging, are increasingly utilized in transabdominal and transanal approaches for rectal cancer surgery. Compared to traditional laparoscopy, robotic systems could educe the technical difficulty of total mesorectal excision (TME) and enhance pelvic autonomic nerve preservation, while demonstrating comparable long-term outcomes. However, the high cost and limited clinical benefits have led to reflection. Controversies persist regarding prolonged operative time, lack of haptic feedback and limited cost-effectiveness. Studies suggest robotic surgery may benefit patients with complex conditions such as obesity, narrow pelvis or low rectal tumors. The rapid development of domestic surgical robots is expected to break market monopolies, reduce costs and expand applications through telemedicine. Future efforts should focus on identifying optimal patient cohorts and generating high-quality evidence to refine the clinical utility of robotic surgery.
| [1] | BIANCHI P P, CERIANI C, LOCATELLI A, et al. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes[J]. Surg Endosc, 2010, 24(11):2888-2894. |
| [2] | YAMAOKA Y, SHIOMI A, KAGAWA H, et al. Robotic surgery for clinical T4 rectal cancer: short-and long-term outcomes[J]. Surg Endosc, 2022, 36(1):91-99. |
| [3] | NG K T, TSIA A K V, CHONG V Y L. Robotic versus conventional laparoscopic surgery for colorectal cancer: a systematic review and meta-analysis with trial sequential analysis[J]. World J Surg, 2019, 43(4):1146-1161. |
| [4] | ATALLAH S, NASSIF G, POLAVARAPU H, et al. Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration[J]. Tech Coloproctol, 2013, 17(4):441-447. |
| [5] | ATALLAH S, MARTIN-PEREZ B, ALBERT M, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution[J]. Tech Coloproctol, 2014, 18(5):473-480. |
| [6] | Atallah S. Assessment of a flexible robotic system for endoluminal applications and transanal total mesorectal excision (taTME): could this be the solution we have been searching for?[J]. Tech Coloproctol, 2017, 21(10):809-814. |
| [7] | 中国医师协会结直肠肿瘤专业委员会机器人手术专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人结直肠癌手术中国专家共识(2020版)[J]. 机器人外科学杂志(中英文), 2021, 2(3):225-240. |
| Professional Committee of Robotic Surgery, Colorectal Cancer Committee of Chinese Medical Doctor Association; Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association. [Chinese expert consensus on robotic surgery for colorectal cancer (2020 edition)]][J]. Chin J Robotic Surg, 2021, 2(3):225-240. | |
| [8] | FENG Q, YUAN W, LI T, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7(11):991-1004. |
| [9] | JAYNE D, PIGAZZI A, MARSHALL H, et al. Effect of robotic-assisted vs. conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomi-zed clinical trial[J]. JAMA, 2017, 318(16):1569-1580. |
| [10] | BAEK S J, KIM C H, CHO M S, et al. Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy[J]. Surg Endosc, 2015, 29(6):1419-1424. |
| [11] | KHAN J S, BANERJEE A K, KIM S H, et al. Robotic rectal surgery has advantages over laparoscopic surgery in selected patients and centres[J]. Colorectal Dis, 2018, 20(10):845-853. |
| [12] | AHMED J, CAO H, PANTELEIMONITIS S, et al. Robotic vs. laparoscopic rectal surgery in high-risk patients[J]. Colorectal Dis, 2017, 19(12):1092-1099. |
| [13] | 项世骏, 韩超, 张人超, 等. 达芬奇机器人辅助单孔加一孔直肠前切除术可行性分析[J]. 中国实用外科杂志, 2023, 43(8):920-924. |
| XIANG S J, HAN C, ZHANG R C, et al. Feasibility of single-incision robotic surgery for rectosigmoid tumor with da Vinci platform[J]. Chin J Pract Surg, 2023, 43(8):920-924. | |
| [14] | GUO Z, SHI Y, SONG Z, et al. Single-incision robotic assisted surgery: a nonrandomized cohort pilot study on a novel surgical platform in colorectal surgery[J]. Int J Surg, 2023, 109(11):3417-3429. |
| [15] | 中华医学会外科学分会结直肠外科学组, 中华医学会外科学分会腹腔镜与内镜外科学组. 直肠癌经肛全直肠系膜切除中国专家共识及临床实践指南(2019版)[J]. 中国实用外科杂志, 2019, 39(11):1121-1128. |
| Colorectal Surgery Group, Chinese Society of Surgery, Chinese Society of Surgery, Laparoscopic and Endoscopic Surgery Group, Chinese Society of Surgery. Chinese expert consensus and clinical practice guideline for transanal total mesorectal excision for rectal cancer (2019 edition)[J]. Chin J Pract Surg, 2019, 39(11):1121-1128. | |
| [16] | LARSEN S G, PFEFFER F, K?RNER H, et al. Norwegian moratorium on transanal total mesorectal excision[J]. Br J Surg, 2019, 106(9):1120-1121. |
| [17] | 郭子超, 程兮. 经肛全直肠系膜切除临床应用的现状及展望[J]. 外科理论与实践, 2022, 27(6):558-562. |
| GUO Z C, CHENG X. Application of transanal total mesorectal excision: status and prospects[J]. J Surg Concepts Pract, 2022, 27(6):558-562. | |
| [18] | RONDELLI F, SANGUINETTI A, POLISTENA A, et al. Robotic transanal total mesorectal excision (RTaTME): state of the art[J]. J Pers Med, 2021, 11(6):584. |
| [19] | REDDAVID R, SOFIA S, PUCA L, et al. Robotic rectal resection for rectal cancer in elderly patients: a systematic review and meta-analysis[J]. J Clin Med, 2023, 12(16):5331. |
| [20] | SEOW W, DUDI-VENKATA N N, BEDRIKOVETSKI S, et al. Outcomes of open vs. laparoscopic vs. robotic vs. transanal total mesorectal excision (TME) for rectal cancer: a network meta-analysis[J]. Tech Coloproctol, 2023, 27(5):345-360. |
| [21] | PRETE F P, PEZZOLLA A, PRETE F, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials[J]. Ann Surg, 2018, 267(6):1034-1046. |
| [22] | SAFIEJKO K, TARKOWSKI R, KOSELAK M, et al. Robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection: a systematic review and meta-analysis of 19,731 patients[J]. Cancers(Basel), 2021, 14(1):180. |
| [23] | YAO Q, SUN Q N, REN J, et al. Comparison of robotic-assisted versus conventional laparoscopic surgery for mid-low rectal cancer: a systematic review and meta-analysis[J]. J Cancer Res Clin Oncol, 2023, 149(16):15207-15217. |
| [24] | LAW W L, FOO D C C. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer[J]. Surg Endosc, 2017, 31(7):2798-2807. |
| [25] | MEMON S, HERIOT A G, MURPHY D G, et al. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis[J]. Ann Surg Oncol, 2012, 19(7):2095-2101. |
| [26] | FUNG A K Y, ALY E H. Robotic colonic surgery: is it advisable to commence a new learning curve?[J]. Dis Colon Rectum, 2013, 56(6):786-796. |
| [27] | BAIK S H, KO Y T, KANG C M, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial[J]. Surg Endosc, 2008, 22(7):1601-1608. |
| [28] | HUANG C W, WEI P L, CHEN C C, et al. Clinical safety and effectiveness of robotic-assisted surgery in patients with rectal cancer: real-world experience over 8 years of multiple institutions with high-volume robotic-assisted surgery[J]. Cancers(Basel), 2022, 14(17):4175. |
| [29] | HUANG Z, LI T, ZHANG G, et al. Comparison of open, laparoscopic, and robotic left colectomy for radical treatment of colon cancer: a retrospective analysis in a consecutive series of 211 patients[J]. World J Surg Oncol, 2022, 20(1):345. |
| [30] | 张雅琦, 张弢, 宋子甲, 等. 倾向评分匹配分析机器人中低位直肠癌根治术的泌尿功能保护作用[J]. 外科理论与实践, 2020, 25(3):245-251. |
| ZHANG Y Q, ZHANG T, SONG Z J, et al. Effect of robotic surgery on urinary function following radical resection for middle and low rectal cancer: a propensity score matching analysis[J]. J Surg Concepts Pract, 2020, 25(3):245-251. | |
| [31] | WANG G, WANG Z, JIANG Z, et al. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer[J]. Int J Med Robot, 2017, 13(1). |
| [32] | 池畔. 腔镜与机器人保留部分邓氏筋膜TME[J]. 中华普通外科学文献(电子版), 2021, 15(4):287. |
| CHI P. Laparoscopic and robotic partially preserved Denonvilliers' fascia in total mesorectal excision[J]. Chin Arch Gen Surg (electronic edition), 2021, 15(4):287. | |
| [33] | PARK E J, CHO M S, BAEK S J, et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery[J]. Ann Surg, 2015, 261(1):129-137. |
| [34] | KIM J, BAEK S J, KANG D W, et al. Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching[J]. Dis Colon Rectum, 2017, 60(3):266-273. |
| [35] | CHEN J, ZHANG Z, CHANG W, et al. Short-term and long-term outcomes in mid and low rectal cancer with robotic surgery[J]. Front Oncol, 2021,11:603073. |
| [36] | CHEN T C, LIANG J T. Robotic versus laparoscopic surgery for rectal cancer after neoadjuvant chemoradiotherapy: a propensity-score matching analysis[J]. J Formos Med Assoc, 2022, 121(8):1532-1540. |
| [37] | PEACOCK O, LIMVORAPITAK T, HU C Y, et al. Robotic rectal cancer surgery: comparative study of the impact of obesity on early outcomes[J]. Br J Surg, 2020, 107(12):1552-1557. |
| [38] | RAO P P. Robotic surgery: new robots and finally some real competition[J]. World J Urol, 2018, 36(4):537-541. |
| [39] | SIMIANU V V, GAERTNER W B, KUNTZ K, et al. Cost-effectiveness evaluation of laparoscopic versus robotic minimally invasive colectomy[J]. Ann Surg, 2020, 272(2):334-341. |
| [40] | THOMAS H. Surgery: robotic assistance confers no be-nefit in rectal cancer surgery[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(12):690-691. |
| [41] | 易波, 雷阳, 张皓, 等. 达芬奇与妙手机器人系统辅助直肠癌直肠全系膜切除短期疗效比较研究[J]. 中国实用外科杂志, 2021, 41(12):1410-1418. |
| YI B, LEI Y, ZHANG H, et al. Comparison of robot-assisted total mesorectal excision for rectal cancer with da Vinci versus Micro Hand S surgical system[J]. Chin J Pract Surg, 2021, 41(12):1410-1418. | |
| [42] | 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. |
| LIU R, ZHAO G D, SUN Y N, et al. Animal experiment for 5G remote robotic surgery[J]. Chin J Laparosc Surg (electronic edition), 2019, 12(1):45-48. | |
| [43] | 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. |
| GU C L, LI L A, WANG N, et al. 5G telesurgery robot-assisted laparoscopic total hysterectomy: first report[J]. Chin J Min Inv Surg, 2023, 23(8):610-615. | |
| [44] | YANG X, WANG Y, 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. |
/
| 〈 |
|
〉 |
