Da Vinci Surgical System 達文西手臂微創手術

Led by Professor Yi-Ming Shyr and Professor Shin-E Wang, Director of the Minimally Invasive Surgery Center, the pancreas team at Taipei Veterans General Hospital has been dedicated to advancing robotic pancreaticoduodenectomy (RPD). Pancreatic surgery—particularly the pancreaticoduodenectomy, also known as the Whipple procedure—is widely recognized in the medical field as one of the most complex and challenging operations. Traditional open pancreaticoduodenectomy (OPD) typically results in large incisions and significant postoperative pain. Therefore, minimally invasive surgery has become a global trend, offering smaller wounds and less postoperative discomfort. However, applying minimally invasive techniques to this intricate and lengthy operation requires a highly experienced and professional pancreatic team.

Our team has published more than 70 academic articles on pancreatic diseases and surgeries, including one textbook chapter and 15 papers focused on robotic pancreatic resection. Due to her outstanding contributions, Professor Shin-E Wang was invited as a speaker at the 13th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA) on September 6, 2018, and was the only representative from Taiwan to participate in drafting the International Guidelines for Minimally Invasive Pancreatic Resection (IG-MIPR), held in Miami, USA, on March 18, 2019.

The team has successfully implemented the da Vinci Robotic Surgical System for the Whipple procedure. To date, we have completed over 1,800 Whipple surgeries and more than 540 robotic RPD cases, achieving the following outstanding results:

• Early Discharge: Patients undergoing RPD were discharged as early as postoperative day 6—nearly a month earlier than those undergoing traditional OPD.

• Minimal Scarring: RPD requires incisions as small as 3–4 cm, compared to the 30–40 cm incisions from traditional OPD, about 1/10 in size.

• Minimal Blood Loss: In two cases, RPD resulted in zero blood loss, with an average of only 100 c.c., far lower than the typical 500 c.c. from OPD.

• Shorter Surgery Time: The shortest RPD operation time was 232 minutes (under 4 hours), significantly shorter than the 6–8 hours required by OPD.

• Feasibility in the Elderly: We successfully performed RPD on a 95-year-old patient, proving its safety and applicability even in elderly individuals.

• Low Surgical Mortality: The surgical mortality rate is less than 1%.

Over 99% of patients who have undergone minimally invasive RPD expressed satisfaction with the results and would recommend this approach to others with periampullary lesions. Taipei Veterans General Hospital ranks first in Taiwan and remains a leading institution in Asia and worldwide for robotic minimally invasive pancreaticoduodenectomy using the da Vinci system.

微創機器手臂胰臟手術 — 大型胰臟手術的小傷口選擇

由台北榮民總醫院胰臟手術團隊的石宜銘教授與微創手術中心主任王心儀教授領軍，持續發展「微創機器手臂胰十二指腸切除術（RPD）」。胰臟手術，尤其是胰十二指腸切除術（又稱 Whipple 手術），是醫學界公認最困難與具挑戰性的手術之一。傳統的開腹胰十二指腸切除術（OPD）常會造成病人術後極為疼痛且傷口大，因此，微創手術成為全球趨勢，能有效縮小傷口並減輕術後疼痛。然而，要將微創技術應用於這項繁複冗長的手術，必須仰賴經驗豐富且高度專業的胰臟醫療團隊。

我們團隊已發表超過70篇與胰臟疾病與手術相關的學術著作，包括一本教科書章節及15篇關於機器手臂胰臟切除術的論文。王心儀主任更因卓越的表現與貢獻，於2018年9月6日受邀擔任第13屆國際肝膽胰協會世界大會（IHPBA）講者，並於2019年3月18日成為台灣唯一受邀參與於美國邁阿密舉辦之《微創胰臟切除術國際指南》（IG-MIPR）制定的專家。

團隊成功地將「達文西機器手臂手術系統」應用於 Whipple 手術。截至目前，我們已完成超過1800例 Whipple 手術與540例以上的微創 RPD，創下以下傑出成就：

1. 提早出院：微創 RPD 術後最快於第6天出院，比傳統手術提早近一個月。

2. 極小傷口：RPD 傷口僅34公分，為傳統手術3040公分傷口的1/10。

3. 幾乎無失血：曾有兩例RPD完全無失血，平均出血量僅約100 c.c.，遠低於傳統手術的500 c.c.。

4. 手術時間短：RPD 最快手術時間為232分鐘（少於4小時），顯著低於傳統手術6~8小時。

5. 高齡可行性：成功完成95歲患者之 RPD，證明此術式對高齡病患亦可行。

6. 低手術死亡率：死亡率低於1%。

超過99%的 RPD 病患對手術結果表示滿意，並願意推薦此術式給其他有壺腹周邊病變的患者。台北榮總在達文西機器手臂微創胰十二指腸切除術的手術量與成果，皆為台灣第一，並位居亞洲乃至全球領先地位。

Surgical Overview

Pelvic organ prolapse is a common health issue in women, affecting up to 50% of those who have given birth. It refers to the descent of pelvic organs—such as the bladder, uterus, vagina, and/or rectum—from their normal positions in the pelvis. In some cases, the organs may protrude through the vaginal opening, causing symptoms like a sensation of pressure or bulging, difficulty with urination or bowel movements, sexual dysfunction, and a significant decline in quality of life.

Surgical Features

Sacrocolpopexy is an important pelvic reconstructive procedure used to treat enterocele and vaginal vault prolapse. It can also provide apical support during hysterectomy. The surgery can be performed via open abdominal surgery, laparoscopy, or with robotic assistance. The main principle of the procedure is to suspend the vaginal apex to the anterior longitudinal ligament located at the sacral promontory.

Surgical Procedure

The procedure begins by opening the peritoneum over the first sacral joint to expose the anterior longitudinal ligament and the middle sacral vessels. The peritoneum over the anterior vaginal wall is then opened to access the rectovaginal and vesicovaginal spaces. After mobilizing the bladder and rectum, the appropriate mesh length is determined. A Y-shaped mesh is secured to the sacrum using 2 to 3 sutures, and the mesh is anchored to the full thickness of both the anterior and posterior vaginal walls using permanent sutures. Finally, the peritoneum is closed over the mesh to cover the bridge between the vaginal apex and sacrum, reducing the risk of adhesions and bowel obstruction.

Risks and Complications

• Injury to the bladder, ureters, or intestines

• Recurrence of prolapse

• Urinary tract infection

• Hemorrhage

• Ileus (bowel obstruction)

• Dyspareunia (pain during intercourse)

• Mesh exposure or erosion

• Urinary incontinence

This procedure combines the effectiveness of traditional surgery with the advantages of minimally invasive techniques, offering significant benefits in reducing postoperative pain and shortening hospital stay and recovery time.

薦骨陰道穹隆懸吊術

骨盆器官脫垂是女性常見的健康問題，影響約高達 50% 有過生育經驗的女性。此症狀是指膀胱、子宮、陰道與/或直腸從正常骨盆位置下垂，有時甚至突出於陰道口，導致下墜感、排尿與排便困難、性功能障礙等問題，進而嚴重影響生活品質。

手術特色

薦骨陰道穹隆懸吊術（Sacrocolpopexy）是一項重要的骨盆重建手術，用於治療腸膨出（enterocele）與陰道穹窿脫垂，也可在子宮切除手術中提供陰道頂端的支撐。手術方法包括經腹式、腹腔鏡與機器手臂輔助手術等方式。其主要原理是將陰道頂部固定至薦骨突前方的縱韌帶上。

手術步驟

手術首先切開薦骨第一節關節前方的腹膜，以顯露前縱韌帶與薦中央血管。接著切開陰道前方腹膜，進入直腸陰道與膀胱陰道間的組織間隙。待直腸與膀胱充分游離後，評估網片長度，使用Y字形網片，其尾端以2至3針縫合固定於薦骨，前後陰道壁以永久縫線全層縫合固定網片。最後再將腹膜縫合覆蓋網片橋接處，以降低沾黏與腸阻塞風險。

風險與併發症

• 膀胱、輸尿管或腸道損傷

• 脫垂復發

• 泌尿道感染

• 出血

• 腸阻塞（腸麻痺）

• 性交疼痛

• 網片外露或侵蝕

• 尿失禁

此手術兼具傳統手術的效果與微創技術的優勢，在減少術後疼痛、縮短住院時間與恢復期方面具有明顯成效。

The benefits of laparoscopy-assisted surgery are well established and include reduced postoperative pain, less pulmonary suppression, fewer wound complications, faster resolution of ileus, reduced adhesion formation, shorter hospital stays, and quicker recovery compared to traditional open surgery.

Patient Selection and Indications

Despite growing expertise, not all patients with colorectal cancer are ideal candidates for minimally invasive surgery. One limiting factor is a history of prior abdominal surgery. Although previous laparotomy is not an absolute contraindication, the ability to safely access the abdominal cavity and perform adhesiolysis must be evaluated on a case-by-case basis. Other potential risk factors cited in the literature include obesity, advanced age, high ASA score, advanced tumor stage, and emergency presentation. Tumors staged as T4 or located in the transverse colon are commonly excluded in randomized trials. However, these factors are considered relative contraindications depending on the surgeon's experience.

Surgical Procedures

Patients are placed in the lithotomy position under general anesthesia, secured to tolerate deep Trendelenburg positioning. Typically, 4 to 5 trocars are inserted regardless of tumor location. CO₂ pneumoperitoneum is maintained at 12–15 mmHg. A median approach is routinely used.

Right Hemicolectomy:

The assistant elevates the mesentery just caudal to the ileocolic vessels. The peritoneum is incised and extended toward the anterior surface of the duodenum, exposing the superior mesenteric vein. The ileocolic artery and vein are divided, and lymphadenectomy is extended cranially to the root of the middle colic artery. The hepatic flexure is mobilized, and care is taken to preserve the duodenum and Gerota's fascia when dissecting the retroperitoneum. The Toldt's fascia is incised as far cranially and caudally as possible. The ileocecal region is then flipped medially while preserving the right ureter and gonadal vessels. The colon is resected and reconstructed either intra- or extracorporeally through a small umbilical incision using hand-sewn or stapled end-to-end or side-to-side ileocolic anastomosis.

Sigmoidectomy:

The medial aspect of the rectosigmoid mesocolon is incised to access the retroperitoneal space, preserving both hypogastric nerves. The inferior mesenteric artery and vein are divided at their origin. The left ureter and gonadal vessels are identified and preserved. Lateral peritoneal reflection is incised and carried to the median layer. Specimen removal and reconstruction are performed extracorporeally. If the distal colon is too short for extracorporeal anastomosis, an intracorporeal colorectal anastomosis using a circular stapler with the double-stapling technique is performed.

Low Anterior Resection:

After division of the main artery, the pelvis is approached. The rectosigmoid colon is retracted cranially, and dissection is performed laterally for optimal pelvic exposure. The peritoneal reflection is incised anteriorly, Denonvilliers' fascia is divided to expose the seminal vesicles in men or vaginal wall in women. The rectum is mobilized to the level of the levator ani. The mesorectum is incised circumferentially, and a 5 cm midline incision is created for insertion of a linear stapler. The rectal stump is irrigated to prevent anastomotic recurrence. The anastomosis is completed using the double-stapling technique with a circular stapler.

Transanal Total Mesorectal Excision (taTME):

After disinfection and adequate anal dilation, a Lone Star Retractor™ is used to expose the anal canal. Depending on tumor location, intersphincteric resection (ISR) may be performed initially. Mucosal circumferential marking is done 1–2 cm below the tumor margin. A 2–0 purse-string suture is placed on the muscular layer and tied to close the rectal lumen. The mesorectum is dissected through the "Holy Plane" of TME until it meets the abdominal dissection plane.

Laparoscopic exploration, dissection of the inferior mesenteric or superior rectal artery root, and mesenteric membrane resection are performed similarly to conventional laparoscopic-assisted TME. Splenic flexure mobilization is performed if needed to allow tension-free anastomosis.

Note:

The specific risks and complications of laparoscopy-assisted colorectal cancer resection are similar to those of open surgery. Long-term oncological outcomes are also comparable to those of open procedures.

腹腔鏡輔助大腸直腸癌切除手術

腹腔鏡輔助手術的優勢已被充分證實，包括術後疼痛較輕、肺功能抑制較少、傷口併發症較少、腸麻痺恢復較快、沾黏風險降低、住院時間縮短及恢復期更快，優於傳統開腹手術。

適應症與病患選擇

即使醫師技術持續進步，並非所有大腸直腸癌患者都適合進行微創手術。其中一個限制因素是曾經接受過腹部手術。既往剖腹手術並非絕對禁忌，但是否可安全進入腹腔並進行沾黏剝離仍須個別評估。其他文獻提出的風險因素包括肥胖、高齡、高 ASA 分級、腫瘤期別較晚或緊急情況等。T4期及橫結腸位置的腫瘤常被排除於隨機試驗之外。不過這些因素是否構成禁忌仍取決於醫師經驗。

手術方式

病人將在全身麻醉下採截石位固定，需能承受深度 Trendelenburg 姿勢。一般會置入4到5個手術通道，不論腫瘤位置如何。手術中維持腹腔內 CO₂ 壓力於 12–15 mmHg。所有手術一般採用中線進入方式。

右側結腸切除術：

由第一助手拉起迴結腸血管尾側的腸繫膜，進行切開，延伸至十二指腸前側，進行迴結腸根部淋巴切除，顯露出腸繫膜上靜脈。切斷迴結腸動、靜脈後，沿腸繫膜上靜脈向上延伸至中結腸動脈根部。接著游離肝曲結腸，分離腹膜後層時需保留十二指腸與Gerrotta筋膜。切開Toldt融合筋膜至最遠端，並自尾側翻轉迴盲區，保留右側輸尿管與性腺血管，向內側完成解剖。右側結腸可於體內或體外切除與重建，經肚臍口做小切口，進行端端或側側吻合，可使用手縫或吻合器。

乙狀結腸切除術：

先切開乙狀直腸繫膜的內側，進行腹膜後游離並保留雙側下腹神經。切斷主動脈起始處的下腸繫膜動脈與同層的靜脈，接著完成左側輸尿管與性腺血管的辨識與保留，切開側腹膜反射層，向中層進行。若腸段太短無法體外吻合，則需進行體內吻合，使用圓形吻合器採雙釘技術進行。

前位低位直腸切除術：

切斷主要動脈後進入骨盆，拉起乙狀結腸，向側方進行剝離，顯露骨盆腔。前側切開腹膜反射層，切除Denonvillier筋膜，顯示男性精囊或女性陰道壁。向下游離直腸至提肛肌環繞。切開腸繫膜後，以5公分中線切口置入線性吻合器，進行腸道清洗避免吻合處復發，使用雙釘吻合技術重建腸道連通性。

經肛門全直腸間質切除術（taTME）：

消毒並充分擴張肛門後，使用 Lone Star Retractor™ 進行暴露。依腫瘤位置選擇是否先行括約肌間切除（ISR），接著於腫瘤下緣1–2公分處對黏膜層作環狀標記。用2–0縫線於肌層作荷包縫合，打結後封閉腸腔。進入TME「神聖平面」，自肛門側分離腸繫膜，與腹腔操作平面會合完成全直腸間質切除術。

腹腔內之探索、下腸繫膜動脈或上直腸動脈根部解剖，以及腸繫膜膜狀組織的切除過程與傳統腹腔鏡輔助 TME 手術相同。必要時也會進行脾曲游離以進行無張力吻合。

注意事項：

腹腔鏡輔助手術的特定風險與併發症與傳統開腹手術相似。其長期腫瘤控制效果與開腹手術相當。

Overview:

Endometrial cancer is the most common gynecologic cancer in developing countries, typically occurring in postmenopausal women. It is commonly diagnosed through transvaginal ultrasound and endometrial biopsy. The standard treatment involves surgery, followed by chemotherapy and/or radiation therapy depending on the case. Robotic-assisted surgery is an effective approach for treating endometrial cancer, offering advantages such as lower surgical complication rates and shorter hospital stays compared to traditional laparoscopy or open surgery.

Features:
The purpose of staging surgery in endometrial cancer is both for treatment and accurate staging. By using indocyanine green (ICG) and real-time fluorescent imaging technology (Firefly®) for sentinel lymph node biopsy and dissection, robotic-assisted surgery provides a more sensitive and precise evaluation of lymph node involvement. Key advantages include reduced blood loss, lower risk of lymphedema and complications, and quicker postoperative recovery.

Procedure:
Pelvic lymphadenectomy is performed before the hysterectomy, and para-aortic lymph node sampling is done afterward. The procedure begins with the injection of fluorescent dye into the cervix. The retroperitoneal space is then opened, and anatomical structures are identified via endoscopic visualization. Lymph nodes are dissected, including distal common iliac nodes, nodes around the external iliac vessels, and obturator nodes. Para-aortic lymph nodes are sampled afterward. The fluorescence dye helps accurately identify lymph nodes, which are collected into a specimen bag. A hysterectomy and bilateral salpingo-oophorectomy are then performed, and the specimen is removed via the vagina. The vaginal cuff and surgical wound are sutured closed.

Risks and Complications:

• Intraoperative complications: injury to vessels, bladder, ureters, or intestines

• Leg pain or edema

• Vaginal cuff bleeding, infection, or leakage

• Postoperative infections such as wound infection, urinary tract infection, pelvic abscess, or peritonitis

• Chylous ascites

• Hematoma

• Severe muscle strain

子宮內膜癌的機器手臂分期手術

手術概述：
子宮內膜癌是開發中國家最常見的女性生殖系統癌症，通常發生在停經後的女性。常見的診斷方式包括經陰道超音波檢查及子宮內膜切片。標準治療方式為手術，術後依情況搭配化學治療或放射治療。機器手臂手術技術是一種適用於子宮內膜癌的治療方式，與傳統腹腔鏡或剖腹手術相比，具有手術併發症低與住院時間短等優勢。

手術特色：
子宮內膜癌的分期手術目的是為了治療與準確分期。透過注射吲哚青綠（Indocyanine Green, ICG）與即時螢光影像系統（Firefly®）進行前哨淋巴結（Sentinel Lymph Node）活檢與清除，機器手臂輔助手術能更敏感且準確地評估淋巴結情況。此手術的優勢包括：出血量少、淋巴水腫與併發症風險較低，以及術後恢復期短。

手術步驟：
在子宮切除手術前先進行骨盆腔淋巴結切除，子宮切除後再進行主動脈旁淋巴結採樣。首先在子宮頸注射螢光染劑，接著開啟腹膜後腔，透過內視鏡辨識解剖構造，進行淋巴結清除，包括遠端總髂淋巴結、外髂動靜脈旁淋巴結與閉孔淋巴結，最後採樣主動脈旁淋巴結。螢光染劑有助於更精確地辨識並收集淋巴結，放置於組織袋中保存。之後進行子宮與雙側輸卵管卵巢切除術，標本經由陰道取出，最後縫合陰道頂端與手術傷口。

風險與併發症：

• 手術中併發症：血管、膀胱、輸尿管或腸道損傷

• 下肢疼痛或水腫

• 陰道頂端出血、感染或滲漏

• 傷口感染、泌尿道感染、骨盆膿瘍或腹膜炎等感染

• 乳糜腹水

• 血腫

• 嚴重肌肉拉傷

Robot-assisted laparoscopic surgery offers several advantages, including minimal invasiveness, reduced blood loss, precise suturing and manipulation for optimal repair results, smaller and more aesthetic wounds, shorter recovery time, and reduced hospital stay.

Overview

Ureteral stricture may result from various causes such as congenital ureteropelvic junction (UPJ) obstruction, iatrogenic injury, inflammation, urolithiasis, or prior endoscopic, pelvic, or retroperitoneal surgeries. Common symptoms include flank pain, recurrent urinary tract infections (UTIs), and hematuria. If left untreated, the condition can lead to hydronephrosis, impaired renal function, and kidney atrophy.

Key Features

We use the Da Vinci robotic-assisted laparoscopic system to reconstruct the narrowed segment of the ureter, relieving obstruction and hydronephrosis.

The goals of treatment include:

• Relieving ureteral obstruction and hydronephrosis to preserve kidney function

• Alleviating symptoms such as flank pain, hematuria, and recurrent UTIs

• Avoiding long-term placement of a double J stent, which may cause discomfort, hematuria, and infection

• Reducing the need for frequent double J stent replacements

Surgical Procedure

Under general anesthesia, the narrowed segment of the ureter is surgically removed. Based on the condition, one of the following reconstructive techniques is performed:

• End-to-end anastomosis of the proximal and distal ureteral ends

• Ureteral reimplantation into the bladder

• Ureteral reconstruction and reimplantation using a Boari flap or Psoas hitch technique

• End-to-side anastomosis between ureters

Notes and Risks

This procedure carries a relatively low risk of complications, which may include:

• Risks related to general anesthesia

• Infection

• Hemorrhage

• Urinary leakage

機器手臂輔助腹腔鏡輸尿管狹窄修復手術

手術特色簡述

採用機器手臂輔助手術具有多項優勢，包括：侵入性低、出血量少、因精密縫合與操作達成最佳修復效果、傷口小且美觀、術後恢復期與住院時間短。

手術概述

輸尿管狹窄常見原因包括先天性腎盂輸尿管連接處狹窄、醫源性損傷、發炎、尿路結石、先前接受的內視鏡、骨盆或後腹腔手術等。常見症狀包括側腹疼痛、反覆泌尿道感染與血尿。若未妥善治療，此疾病會導致腎積水，進而造成腎功能受損與腎臟萎縮。

手術特點

我們使用 Da Vinci 達文西機器手臂輔助腹腔鏡技術來修復輸尿管狹窄部位，以解除阻塞與腎積水。

治療目標包括：

• 解除輸尿管阻塞與腎積水，保留腎功能。

• 緩解側腹疼痛、血尿與反覆泌尿道感染等症狀。

• 避免長期置放雙J導管（Double J stent）所引起的不適症狀。

• 避免患者需頻繁更換雙J導管所帶來的困擾。

手術方式

在全身麻醉下，切除狹窄的輸尿管段，並根據狀況採取以下其中一種修復方式：

• 輸尿管近端與遠端直接端對端吻合

• 輸尿管重新植入膀胱

• 使用 Boari flap 或 Psoas hitch 技術進行輸尿管重建與重新植入

• 輸尿管間的端對側吻合

注意事項

此手術風險與併發症相對較低，可能包括：

• 全身麻醉風險

• 感染

• 出血

• 尿液滲漏

For patients diagnosed with small kidney tumors, robotic-assisted partial nephrectomy (RaPN) is a safe and minimally invasive surgical option that allows for effective tumor removal while preserving healthy kidney tissue.

Features

Robotic-assisted partial nephrectomy (RaPN) is a safe and feasible alternative to traditional open or laparoscopic partial nephrectomy for the treatment of early-stage renal cell carcinoma. Compared to open surgery, RaPN offers improved cosmetic outcomes, less postoperative pain, reduced blood loss, and shorter hospital stays. Compared to laparoscopic surgery, RaPN provides the advantages of shorter hospitalization, less intraoperative bleeding, and reduced warm ischemia time.

Procedure Steps

The main steps of the current surgical technique include:

1. Patient positioning and trocar placement

2. Bowel mobilization and dissection of the renal hilum

3. Tumor localization and demarcation

4. Clamping of the renal vessels and tumor excision

5. Renorrhaphy (repair of the kidney)

6. Unclamping of the renal vessels

7. Tumor specimen retrieval

機器手臂輔助腎單位保留手術

對於被診斷出有小型腎腫瘤的患者，機器手臂輔助腎部分切除術（RaPN）是一種安全且微創的腫瘤切除方式，能保留健康的腎臟組織。

手術特點

機器手臂輔助腎部分切除術（RaPN）是傳統開刀或腹腔鏡腎部分切除術的安全且可行的替代方案，適用於治療早期腎細胞癌。與傳統開放式手術相比，RaPN 提供了更佳的傷口美觀性、減少術後疼痛、出血量與住院時間；與腹腔鏡手術相比，RaPN 在縮短住院天數、降低術中出血與減少「溫缺血時間」方面表現更佳。

手術步驟

目前的手術技術主要包括以下步驟：

1. 病人定位與穿刺孔擺位

2. 腸道游離與腎門解剖

3. 腫瘤定位與劃界

4. 夾閉腎門血管並切除腫瘤

5. 腎臟縫合修補（Renorrhaphy）

6. 鬆開血管夾

7. 取出腫瘤標本

The advantages of minimally invasive total hip arthroplasty include a smaller wound size with better cosmesis, less damage of hip muscle (abductors, gluteus medius and minimus) to facilitate early recovery without the need of walking aids.

Overview

Advanced stage of hip diseases including osteoarthritis, traumatic osteoarthritis, osteonecrosis of the femoral head, rheumatoid arthritis, ankylosing spondylitis associated arthritis and hemophilic arthritis of the hip can lead to severe functional impairment and limping because of pain and limited range of motion. Total hip arthroplasty surgery can bring to a smooth articulating surface (resurfacing) as well as to lengthen the affected leg and minimize leg length discrepancy.

Procedures and Features

• Minimally invasive surgery

Mean operation time of minimally invasive total hip arthroplasty would be around 50 minutes only or less. Average wound size would be less than 8 to 10 centimeters. More importantly, we do less damage to abductor muscles during the surgery, compared with traditional surgical approaches, thus minimize the incidence of limping after surgery. Walking aids are usually required for only 2 weeks or less after surgery.

• Multimodal pain control management

Combined oral, intra-venous or patient-controlled analgesia devices greatly facilitate early rehabilitation and patient satisfaction. Almost all patients can walk well on post-operative day 1 with our pain management.

• Venous thromboembolism prevention protocol

VTE (venous thromboembolism) is one of the common complications following total knee arthroplasty, but can be well prevented. Combination of intravenous low molecular weight heparin, low dose aspirin, factor Xa inhibitor in our protocol can effectively protect against this complication.

• Professional rehabilitation program

Our team, composed of experienced orthopedic doctors, rehabilitation doctors, physical therapists, special nurses can help patients with their post-operative rehabilitation protocol, including proper body positioning, walking independently with or without walking aids, walking up- or downstairs and to deal with common questions after surgery.

微創全髖關節置換術

微創全髖關節置換術具有多項優勢，包括：傷口較小且外觀較佳、美觀性更高，對髖部肌肉（如外展肌、臀中肌與臀小肌）的破壞較少，有助於術後早期恢復，通常不需要長期使用助行器。

晚期髖關節疾病如骨關節炎、創傷性骨關節炎、股骨頭壞死、類風濕性關節炎、僵直性脊椎炎相關關節炎與血友病性髖關節炎，會導致劇烈疼痛與活動受限，進而造成跛行與嚴重功能障礙。全髖關節置換術可提供平滑的關節面（重新表面化），並延長患側腿長，改善雙腿長度不一致的問題。

手術特色與流程

🔹 微創手術
微創全髖關節置換術平均手術時間約為 50 分鐘或更短，傷口大小平均小於 8～10 公分。更重要的是，與傳統手術方式相比，對外展肌的破壞顯著減少，因此術後跛行的機率較低。大多數患者術後只需使用助行器約 2 週或更短。

🔹 多模式疼痛控制
我們結合口服、靜脈注射與病患自控式止痛設備，能有效控制術後疼痛，大幅提升早期復健進度與病患滿意度。幾乎所有患者都能在手術隔日順利行走。

🔹 靜脈血栓栓塞（VTE）預防方案
VTE 是全膝或全髖關節置換術後常見併發症之一，但可有效預防。我們使用靜脈注射低分子量肝素、低劑量阿斯匹靈與第 Xa 因子抑制劑的組合治療方案，有效降低血栓風險。

🔹 專業術後復健計畫
我們的專業團隊由骨科醫師、復健科醫師、物理治療師與專科護理師組成，提供完善的術後復健計畫，包括正確的身體擺位、逐步恢復獨立行走（有無助行器）、上下樓梯訓練，以及常見問題的指導與處理。

The advantages of minimally invasive total knee arthroplasty include a smaller wound size with better cosmesis, less damage of thigh muscle (quadriceps, vastus medialis) to facilitate early recovery without the need of walking aids.

Overview

Advanced stage of arthritis including osteoarthritis, rheumatoid arthritis, gouty arthritis, traumatic osteoarthritis and spontaneous osteonecrosis of the knee can lead to severe functional impairment because of pain, joint effusion, deformity and limited range of motion. Total knee arthroplasty surgery can bring to a new, smooth articulating surface(resurfacing) as well as to straighten the affected leg (realignment), which is one of the most satisfying surgery in the field of Orthopedics.

Procedures and Features

• Minimally invasive surgery

Mean operation time of minimally invasive total knee arthroplasty would be around 30 minutes only or less; simultaneous bilateral total knee arthroplasty would take around 70 minutes or less. Wound size would be approximately 8 to 10 centimeters. More importantly, we do less damage to quadriceps muscle during the surgery, compared with traditional surgical approaches. Therefore, walking aids after surgery are usually not required.

• Multimodal patient blood management

We have standard protocol including intra-articular medication to reduce blood loss as well as post-operative blood transfusion, which makes patients safe and comfortable even undergoing simultaneous bilateral total knee arthroplasty.

• Multimodal pain control management

Combined oral, intra-venous or patient-controlled analgesia devices greatly facilitate early rehabilitation and patient satisfaction. Almost all patients can walk well on post-operative day 1 with our pain management.

• Venous thromboembolism prevention protocol

VTE (venous thromboembolism) is one of the common complications following total knee arthroplasty, but can be well prevented. Combination of intravenous low molecular weight heparin, low dose aspirin, factor Xa inhibitor in our protocol can effectively protect against this complication.

• Professional rehabilitation program

Our team, composed of experienced orthopedic doctors, rehabilitation doctors, physical therapists, special nurses can help patients with their post-operative rehabilitation protocol, including continuous passive range of motion exercises with machines, ice-packing, walking independently with or without walking aids, walking up- or downstairs and to deal with common questions after surgery.

微創全膝關節置換術

微創全膝關節置換術具備多項優勢，包括：傷口較小、美觀性更佳，對大腿肌肉（如股四頭肌與內側廣肌）損傷較少，有助於術後早期恢復，通常不需長期依賴助行器。

概述
膝關節的晚期關節疾病，例如骨關節炎、類風濕性關節炎、痛風性關節炎、創傷性骨關節炎及自發性膝骨壞死，常伴隨疼痛、關節積水、畸形與活動受限，造成嚴重的功能障礙。全膝關節置換手術能提供全新的光滑關節面（關節表面重建）與矯正患側下肢變形（肢體重新對線），被認為是骨科領域中最具病患滿意度的手術之一。

手術特色與流程

🔹 微創手術
微創全膝關節置換術的平均手術時間約為 30 分鐘或更短；若進行雙膝同時置換，則約 70 分鐘以內。傷口長度大約為 8 至 10 公分。最重要的是，手術過程中對股四頭肌的損傷遠低於傳統手術方式，因此大多數患者術後不需依賴助行器。

🔹 多模式病患出血管理
我們制定了標準化出血控制方案，包含關節內用藥以減少出血，以及術後視情況補充輸血，即使雙膝同時手術，病患仍能安全舒適地恢復。

🔹 多模式疼痛控制
結合口服藥物、靜脈注射與病患自控止痛設備，有效減輕術後疼痛，促進病患早期活動與高度滿意度。幾乎所有病患在術後第一天即可開始行走。

🔹 靜脈血栓栓塞（VTE）預防方案
VTE 是全膝關節置換後常見併發症之一，但可透過完善策略預防。我們的標準治療組合包含靜脈注射低分子量肝素、低劑量阿斯匹靈與第 Xa 因子抑制劑，可有效降低血栓風險。

🔹 專業術後復健計畫
我們的團隊由經驗豐富的骨科醫師、復健醫師、物理治療師與專業護理師組成，提供完整的術後復健流程，包含：

• 使用關節活動機器進行被動運動訓練

• 局部冰敷消腫

• 漸進式恢復獨立行走（有無助行器）

• 上下樓梯訓練

• 解答術後常見問題並提供生活指導