机器人胰腺手术国际共识指南(2023版)进展与思考
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作者单位:

1.中国人民解放军总医院第一医学中心 肝胆胰外科医学部,北京 100853;2.中国人民解放军医学院,北京 100853

作者简介:

曹雨,中国人民解放军总医院第一医学中心硕士研究生,主要从事肝胆胰外科方面的研究。

基金项目:

科技创新2030-“新一代人工智能”重大基金资助项目(2021ZD0113301);北京市AI+健康协同创新培育课题基金资助项目(Z221100003522005)。


Advancements and deliberation on the International Consensus Guidelines on Robotic Pancreatic Surgery (2023 Edition)
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Affiliation:

1.Department of Hepatobiliary Pancreatic Surgery, First Medical Center, General Hospital of People's Liberation Army of China, Beijing 100853, China;2.Chinese People's Liberation Army Medical School, Beijing 100853, China

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    摘要:

    随着机器人外科技术和应用的进步,其在胰腺手术领域的应用前景也愈加宽广。近年来研究表明,在部分方面上,机器人胰腺手术与开腹、腹腔镜手术方式相比存在其独特优势。国际微创外科领域呈现不断发展进步的态势,但机器人胰腺手术在临床上的全方面应用仍需要循证医学指导,笔者团队在2019年的《机器人胰腺手术国际共识声明》的基础上牵头更新并在Hepatobiliary Surgery and Nutrition杂志上发表了《机器人胰腺手术国际共识指南(2023版)》,汇聚来自美国、欧洲和大洋洲等国际的众多微创手术专家,采用世界卫生组织(WHO)《指南制定手册》、GRADE网格法、德尔菲投票法和AGREE-Ⅱ工具,就系统文献评价后纳入的176项研究进行分析,在机器人胰十二指肠切除术、机器人远端胰腺切除术、机器人胰腺中段切除术等话题上进行了详细阐述,经过专家评估和对证据质量及可信度的综合评判,提出了19个问题和14项建议,有望为我国及国际范围内的综合、专科医院安全、有效开展机器人胰腺手术推广应用提供依据。新版共识还就多个问题指出随机对照研究证据的重要性,这也是促进机器人胰腺手术安全、有效推广进一步努力的方向。

    Abstract:

    With advancements in robotic surgery technology and applications, its prospects in pancreatic surgery are becoming increasingly promising. Recent studies have shown that robotic pancreatic surgery has unique advantages over open and laparoscopic methods in certain aspects. While the international minimally invasive surgery field continues to evolve, the comprehensive clinical application of robotic pancreatic surgery still requires evidence-based medical guidance. Our team has taken the lead in updating and publishing the International Consensus Guidelines for Robotic Pancreatic Surgery (2023 Edition) in the journal Hepatobiliary Surgery and Nutrition, based on the International consensus statement on robotic pancreatic surgery This effort brought together numerous experts in minimally invasive surgery from the United States, Europe, and Oceania. The analysis of 176 studies included after systematic literature evaluation was conducted using the World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and AGREE-Ⅱ instrument. Detailed discussions were provided on topics such as robotic pancreatoduodenectomy, robotic distal pancreatectomy, and robotic central pancreatectomy. Following expert assessments and a comprehensive evaluation of evidence quality and credibility, 19 questions and 14 recommendations were proposed, aiming to provide a basis for the safe and effective promotion of robotic pancreatic surgery in comprehensive or specialty medical centers both in China and elsewhere. The new consensus also emphasizes the importance of randomized controlled trial evidence for several issues, highlighting a direction for further efforts to promote the safe and effective implementation of robotic pancreatic surgery.

    图1 胰腺端-端吻合术示意图[34]Fig.1 Schematic of end-to-end pancreatic anastomosis[34]
    图2 胰腺缝合模型拉伸模拟结果[36] A:胰腺缝合模型拉伸载荷下的应力分布云图;B:拉伸力-位移曲线Fig.2 Stretching simulation results of the pancreas suture model[36] A: Stress distribution nephogram of pancreas suture model under tensile load; B: Tensile force-displacement curve
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曹雨,张修平,刘荣.机器人胰腺手术国际共识指南(2023版)进展与思考[J].中国普通外科杂志,2024,33(9):1406-1413.
DOI:10.7659/j. issn.1005-6947.2024.09.007

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  • 收稿日期:2024-09-05
  • 最后修改日期:2024-09-20
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  • 在线发布日期: 2024-10-12