柔性臂消化内镜手术机器人在食管内镜黏膜下剥离术中的应用效果

Application of flexible auxiliary single-arm transluminal endoscopic robot in esophageal endoscopic submucosal dissection

摘要:

目的 比较柔性臂消化内镜手术机器人（FASTER）辅助食管内镜黏膜下剥离术（ESD）和传统食管ESD的临床效果，以探索更安全、高效的ESD手术方法。方法 分别采用FASTER辅助ESD和传统ESD方法在离体猪食管模型中进行手术操作。对比分析两组手术总时间、ESD时间、直视剥离率、整体切除率和并发症发生率的差异。结果 FASTER辅助ESD组的手术总时间［（19.2±2.9）和（28.9±8.2）min］和ESD时间［（13.0±2.9）和（21.6±8.3）min］明显短于传统ESD组，差异均有统计学意义（P < 0.01）；直视剥离率明显高于传统ESD组（96.2%和65.4%），差异有统计学意义（P = 0.014）；肌层损伤率明显低于传统ESD组（19.2%和69.2%），差异有统计学意义（P < 0.01）。两组完整切除率和穿孔率比较，差异均无统计学意义（P > 0.05）。这些优势在食管非重力位病变中更加明显。结论 FASTER辅助下的食管ESD较传统ESD更加安全和高效。

Abstract:

Objective To compare the efficacy of endoscopic submucosal dissection (ESD) using the flexible auxiliary single-arm transluminal endoscopic robot (FASTER) with that of the traditional technique, and explore a safer and more efficient ESD operation method.Methods FASTER-assisted ESD and traditional ESD were used to operate in the isolated pig esophagus model. The differences of total procedure time, ESD time, the rate of direct-vision dissection,complete en bloc resection and complication rate between the two groups were compared and analyzed.Results The total procedure time [(19.2 ± 2.9) and (28.9 ± 8.2) min] and ESD time [(13.0 ± 2.9) and (21.6 ± 8.3) min] were significantly shorter in FASTER-assisted ESD group than those in traditional ESD group, the differences were statistically significant (P < 0.01); The rate of direct-vision dissection was significantly higher than that of the traditional ESD (96.2% and 65.4%), the difference was statistically significant (P = 0.014). Muscle layer injury rate was significantly lower than of the traditional group (19.2% and 69.2%), the difference was statistically significant (P < 0.01). There was no significant difference in complete en bloc resection rate and perforation rate between the two groups (P > 0.05). These advantages were more apparent in esophageal non-gravity lesions.Conclusion Esophageal ESD assisted by FASTER is safer and more efficient than traditional ESD.