机器人辅助经自然孔道内镜手术当前应用、优势及未来发展方向

A Review of Robotic vNOTES Surgery: Current Applications, Advantages, and Future Directions

摘要

在过去的500年中，阴道手术、腹腔镜手术与机器人技术三条独立发展的技术路径逐步走向融合，最终催生了机器人辅助经自然孔道内镜手术（robot-assisted vaginal natural orifice transluminal endoscopic surgery, RA-vNOTES）。阴道手术的不断演进，推动了子宫切除、肌瘤剔除、骶骨阴道固定、附件手术及肿瘤手术等现代术式的形成，这些术式现已广泛应用于多种疾病诊断与病理类型。对患者而言，该方法具有显著优势，包括创伤更小、美容效果更佳、术后疼痛更轻、感染率更低，且能更快恢复到术前的健康状态。对医生来说，则可获得更符合人体工学的手术姿势、更清晰的视野、能同时操作多种器械的能力，以及更有效的手部抖动控制。机器人辅助技术大幅拓展了安全实施复杂手术的可能性，例如切除伴有后穹窿完全闭锁的Ⅳ期子宫内膜异位症，以及其他传统阴道手术难以处理的病例。本文介绍RA-vNOTES的最新研究进展，并探讨机器人手术在未来如何进一步优化微创技术。

Abstract

Over the past 500 years, the convergence of three distinct paths – vaginal surgery, laparoscopy, and robotic technologies – has enabled the development of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES). The ongoing evolution of vaginal surgery has led to contemporary procedures such as hysterectomy, myomectomy, sacrocolpopexy, adnexal interventions, and oncologic operations, applicable to a wide range of diagnoses and pathologies. This approach offers patients significant benefits, including superior cosmetic outcomes, less pain, lower infection rates, and faster recovery of baseline quality of life. Surgeons benefit from improved ergonomics, better visualization, the ability to use multiple instruments, and enhanced tremor control. Robotic assistance has greatly expanded the ability to safely perform more complex cases, such as excision of stage 4 endometriosis with complete posterior cul-de-sac obliteration, as well as other procedures previously considered contraindicated in traditional vaginal surgery. Here, we present current findings and advances in RA-vNOTES and consider future developments in robotic surgery aimed at further improving minimally invasive techniques.

关键词

机器人手术 / vNOTES / 妇科 / 微创手术 / 外科创新 / 综述

Key words

Robotic surgery / vNOTES / Gynecology / Minimally invasive surgery / Surgical innovation / Review

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