ID 109639
タイトルヨミ
ヒニョウキカ リョウイキ ニオケル ロボット シエン シュジュツ ノ ゲンジョウ ト カダイ
タイトル別表記
Current opinion in urologic robot-assisted surgery
著者
藤澤, 正人 神戸大学医学研究科外科系講座腎泌尿器科学分野
キーワード
RALP
RAPN
Robot-assisted surgery
資料タイプ
学術雑誌論文
抄録
There has been a dramatic change in the management of the urologic diseases replacing open surgery by minimally invasive surgeries. Robotic-assisted surgery provides a precise, highly magnified 3-D view and less venous oozing associated with pneumoperitoneum, which has led to a better anatomical understanding of fine structures. It also offers finger-controlled movement and the Endowrist technology that allows for a greater degree of freedom of laparoscopic instruments. Great progress has been made in urologic surgery such as radical prostatectomy or partial nephrectomy during the past several years.

Robot-assisted radical prostatectomy (RARP)
Laparoscopic procedure was first introduced to radical prostatectomy in 1997. Although laparoscopic radical prostatectomy had a steep learning curve, it was less invasive and enabled more precise observation of architecture. The da Vinci surgical system was developed in 1999. Afterward, robot-assisted radical prostatectomy was initially reported in 2001. Since the operative procedure was established by Menon et al. the next year, RALP has been widely expanded. RARP has been reported to have less blood loss and complication rate, better functional outcome, and equivalent oncological outcome compared to open or laparoscopic radical prostatectomies. The appearance of RARP allowed for precise recognition of the structures related to radical prostatectomy. Further discussion on appropriate case selection and operative methods is necessary. In addition, studies involving intraoperative visualization of nerves or cancer sites should also be desired.

Robot-assisted partial nephrectomy (RAPN)
Nephron-sparing surgery has become the standard of care for surgical extirpation of small renal masses. Robot-assisted laparoscopic surgery offers peculiar features, such as 7 degrees of motion, 3-dimensional visualization, improved dexterity, and elimination of physiologic tremors. These characteristics potentially allow RAPN to provide decreased intraoperative estimated blood loss (EBL) and shortened warm ischemia time (WIT) and operative time compared with the laparoscopic approach. Some previous studies showed that RAPN offers better outcomes to laparoscopic partial nephrectomy.

Problems solved in the future
Validation of cost-efficiency has not yet been elucidated. The future of medicine may lie in translational approaches individualizing the treatment by further improvement of imaging technology. Further physiological or intraoperative imaging study should also be encouraged. To establish reliable training system is also expected.
掲載誌名
四国医学雑誌
ISSN
00373699
cat書誌ID
AN00102041
出版者
徳島医学会
69
5-6
開始ページ
195
終了ページ
200
並び順
195
発行日
2013-12-25
フルテキストファイル
言語
jpn
著者版フラグ
出版社版