机器人食管切除术后的力反馈与声带功能障碍：da Vinci 5与Xi系统的比较
Force feedback and vocal cord dysfunction after robotic esophagectomy: a comparison of the da Vinci 5 and Xi systems.
文献信息
| PMID | 42860481 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Cho Eun Lee |
| 作者单位 | Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. |
| 期刊 | Journal of robotic surgery |
| SCI 分区 | Q1 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： da Vinci 5（DV5）是首个整合力反馈（FFB）的机器人平台，可能限制过度牵拉和组织损伤。其在机器人经胸食管切除术中的临床影响仍不明确。我们比较了da Vinci Xi与DV5系统的围手术期结局。方法：这项回顾性研究纳入了2024年12月至2026年7月期间由单一高手术量外科医生连续实施的因食管鳞状细胞癌行机器人经胸食管切除术的患者。比较了使用无FFB的Xi系统治疗的患者（n=126）与使用有FFB的DV5系统治疗的患者（n=37）。声带功能障碍（麻痹或活动减弱）通过常规术后喉镜检查评估。结局采用多变量logistic回归分析，并以稳定化逆概率治疗加权（IPTW）作为敏感性分析。结果：DV5组声带功能障碍发生率较低（Xi，33.3% vs. DV5，13.5%），且在多变量和IPTW调整后该关联持续存在（调整比值比[OR]，0.33；IPTW OR，0.27）。声带麻痹发生率也较低（27.8% vs. 10.8%），尽管调整后差异不显著。在一项探索性分析中，DV5组总体30天并发症发生率较低（74.6% vs. 54.1%；调整OR，0.43），但IPTW调整后差异减弱。总淋巴结和喉返神经淋巴结清扫数目无差异。结论：整合FFB的DV5与声带功能障碍发生率较低及手术结局相当相关。这些发现可能提供首个临床数据，提示FFB可减少机器人食管切除术中牵拉相关的神经损伤。
英文摘要
The da Vinci 5 (DV5) is the first robotic platform to integrate force feedback (FFB), which may limit excessive traction and tissue injury. Its clinical impact in robotic transthoracic esophagectomy remains unclear. We compared perioperative outcomes between the da Vinci Xi and DV5 systems. This retrospective study included consecutive patients who underwent robotic transthoracic esophagectomy for esophageal squamous cell carcinoma by a single high-volume surgeon between December 2024 and July 2026. Patients treated with the Xi system without FFB (n = 126) and the DV5 system with FFB (n = 37) were compared. Vocal cord dysfunction (palsy or hypomobility) was assessed by routine postoperative laryngoscopy. Outcomes were analyzed using multivariable logistic regression, with stabilized inverse probability of treatment weighting (IPTW) as a sensitivity analysis. Vocal cord dysfunction was less frequent in the DV5 group (Xi, 33.3% vs. DV5, 13.5%), and the association persisted after multivariable and IPTW adjustment (adjusted odds ratio [OR], 0.33; IPTW OR, 0.27). Vocal cord palsy was also less frequent (27.8% vs. 10.8%), although the difference was not significant after adjustment. In an exploratory analysis, overall 30-day complications were less frequent in the DV5 group (74.6% vs. 54.1%; adjusted OR, 0.43), but the difference was attenuated after IPTW adjustment. Total and recurrent laryngeal nerve lymph node yields did not differ. DV5 with integrated FFB was associated with less frequent vocal cord dysfunction and comparable operative outcomes. These findings may provide the first clinical data suggesting FFB could reduce traction-related nerve injury in robotic esophagectomy.