Using Remotely Operated Suction Irrigation System in da Vinci SP Submucosal Dissection.

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Kamil Erozkan,Olga Lavryk,Emre Gorgun
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引用次数: 0

Abstract

BACKGROUND Submucosal dissection using the da Vinci SP® system (Intuitive Surgical, Sunnyvale, CA, USA) is an emerging approach for treating premalignant lesions in the colon and rectum. The endoluminal space is tight and small, and during the procedure, this tight space is accessed by the 40 mm GelPOINT® Path transanal platform (Applied Medical, Rancho Santa Margarita, CA, USA). Most of the trocar space is occupied by the 25 mm port of the da Vinci SP® system. There is limited space for an additional trocar, and the full mobility of this trocar is restricted; hence there is a need for an effective suction irrigator during these procedures. Although the da Vinci SP® system has four instrument capabilities, it does not have a suction irrigation instrument. To address this issue, we tested a Remotely Operated Suction Irrigation System (ROSI™) (VTI, Nashua, NH, USA) in three patients undergoing da Vinci SP® submucosal dissection. IMPACT OF INNOVATION The impact of innovation is the evaluation of a flexible suction irrigator during endorobotic submucosal dissection (ERSD), addressing space constraints and enhancing surgical precision. TECHNOLOGY MATERIALS AND METHODS This was a single-center retrospective observational study involving three patients who underwent ERSD, between February 2023 and May 2023. ROSI™ was used selectively for rectal lesions. PRELIMINARY RESULTS The first patient was a 67-year-old male with a 30 mm tubulovillous adenoma found in the rectum at 4 cm. The second patient was a 49-year-old female, referred after a screening colonoscopy, with a 40 mm rectal mass 12 cm from the anal verge. A biopsy revealed a tubular adenoma without dysplasia. The last patient was a 66-year-old male with a 25 mm tubulovillous adenoma with a focal high-grade dysplasia at 10 cm. There was no evidence of invasive carcinoma or lymph node metastasis on MRI in any of the patients. The patients were placed in a modified lithotomy position, and the GelPOINT® Path was inserted. A silk suture was attached at the proximal end of ROSI™ to facilitate tubing manipulation. ROSI™ was freely passed into the endoluminal space through the gel using a surgical clamp. Any bleeding during the operation was aspirated and irrigated using ROSI™ with the assistance of bipolar forceps. All surgeries were completed without complications and the patients were discharged on the same day. CONCLUSION AND FUTURE DIRECTIONS ROSI™ is a flexible foot pedal-controlled suction irrigator that can facilitate da Vinci SP® submucosal dissection. The flexibility and controllability of ROSI in the surgeon's hand may qualify it as an essential tool for performing ERSD and possibly other TAMIS procedures.
在达芬奇 SP 粘膜下剥离术中使用遥控抽吸冲洗系统
背景使用达芬奇 SP® 系统(Intuitive Surgical,Sunnyvale,CA,USA)进行粘膜下剥离是治疗结肠和直肠恶性病变的一种新兴方法。腔内空间狭小,在手术过程中,40 毫米的 GelPOINT® Path 经肛门平台(Applied Medical,Rancho Santa Margarita,CA,USA)可以进入这个狭小的空间。大部分套管空间被达芬奇 SP® 系统的 25 毫米端口占据。用于额外套管的空间有限,而且该套管的完全移动性受到限制;因此在这些手术中需要一个有效的抽吸灌洗器。尽管达芬奇 SP® 系统具有四种器械功能,但却没有抽吸灌洗器械。为了解决这个问题,我们在三名接受达芬奇 SP® 粘膜下剥离术的患者身上测试了远程操作抽吸灌洗系统 (ROSI™)(VTI,美国新罕布什尔州纳舒亚市)。创新的影响创新的影响是在机器人内粘膜下剥离术(ERSD)中对灵活的抽吸灌洗器进行评估,解决空间限制问题并提高手术精度。第一位患者是一名 67 岁的男性,直肠内发现一个 30 毫米的管状腺瘤,瘤体 4 厘米。第二名患者是一名 49 岁的女性,在结肠镜筛查后转诊,直肠肿块距离肛门边缘 12 厘米,直径 40 毫米。活检显示为管状腺瘤,无发育不良。最后一名患者是一名 66 岁的男性,患有 25 毫米的管状腺瘤,10 厘米处有一局灶性高级别发育不良。所有患者的核磁共振检查均未发现浸润癌或淋巴结转移的迹象。将患者置于改良的截石位,然后插入 GelPOINT® Path。在 ROSI™ 近端连接了丝线缝合线,以方便管道操作。使用手术钳将 ROSI™ 通过凝胶自由进入腔内空间。在双极镊子的协助下,使用 ROSI™ 抽吸和冲洗手术过程中的任何出血。所有手术均在无并发症的情况下完成,患者于当天出院。结论和未来方向ROSI™是一种灵活的脚踏控制抽吸灌洗器,可用于达芬奇SP®粘膜下剥离术。ROSI 在外科医生手中的灵活性和可控性使其成为进行 ERSD 和其他 TAMIS 手术的必要工具。
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来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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