动态麻醉保障跨洲际超远程机器人肾部分切除术动物零体动的可行性研究

doi:10.12300/j.issn.1674-5817.2025.143

实验动物与比较医学 ›› 2026, Vol. 46 ›› Issue (3): 397-407.DOI: 10.12300/j.issn.1674-5817.2025.143

动态麻醉保障跨洲际超远程机器人肾部分切除术动物零体动的可行性研究

刘意抒¹(), 王正², 来娟³, 蔡丽萍³()()

^1.海军军医大学第三附属医院内科学与野战内科学教研室, 上海 200438
^2.海军军医大学第一附属医院泌尿外科, 上海 200433
^3.海军军医大学第一附属医院临床教育中心, 上海 200433

收稿日期:2025-09-11 修回日期:2025-11-27 出版日期:2026-06-25 发布日期:2026-06-19
通讯作者: 蔡丽萍（1983—），女，硕士，副主任技师，研究方向：实验动物应用研究、医学模拟教育。E-mail：ccg9115@126.com。ORCID：0009-0003-5485-5506
作者简介:刘意抒（1988—），女，硕士，副教授，研究方向：医学模拟教育、高等医学教育。E-mail：yishu1128@163.com。ORCID：0009-0002-2989-4557
基金资助:
教育部产学合作协同育人项目“虚拟现实技术在腹腔镜手术培训中的应用研究”(241005236213411)

Feasibility Study of a Dynamic Anesthetic Strategy for Ensuring Zero Body Movement in Animals During Transcontinental Ultra-Remote Robotic Partial Nephrectomy

LIU Yishu¹(), WANG Zheng², LAI Juan³, CAI Liping³()()

^1.Department of Internal Medicine and Field Internal Medicine, The Third Affiliated Hospital of Naval Medical University, Shanghai 200438, China
^2.Department of Urology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
^3.Clinical Education Center, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China

Received:2025-09-11 Revised:2025-11-27 Published:2026-06-25 Online:2026-06-19
Correspondence to: CAI Liping (ORCID: 0009-0003-5485-5506), E-mail: ccg9115@126.com

摘要/Abstract

摘要：

目的验证在跨越13 000 km、平均网络延迟204 ms的跨洲际超远程环境下，使用单孔腔镜手术机器人对实验猪进行肾部分切除术（partial nephrectomy，PN）的技术可行性及安全性，并探索一种可有效预防术中动物体动的动态复合麻醉策略。方法研究团队在中国上海和美国奥兰多各使用1头实验猪，采用同型号单孔腔镜手术机器人系统进行双向远程手术。麻醉方案包括：术前给予0.02 mg/kg盐酸右美托咪定和0.05 mg/kg枸橼酸芬太尼联合镇静镇痛；在远程手术中，依据动物反射活动、疼痛反应及四个成串刺激（train-of-four stimulation，TOF）计数结果，以0.04 mg·kg^-1·h^-1为起始速率持续输注维库溴铵，并动态调整剂量，配合异氟烷吸入麻醉，维持动物处于深度神经肌肉阻滞状态（TOF=0），防止术中体动。此外，术中全程监测心率、血压、肌松程度等指标。结果上海和奥兰多两地均成功实施手术操作，网络延迟稳定在202～208 ms，数据丢包率为0%，机器人设备无故障。中国上海的实验动物生命体征保持平稳，全程零体动，术中出血量可控，未出现异常出血。结论在固有网络延迟的超远程跨洲际机器人手术中，采用动态调整的麻醉策略能够有效避免动物体动引发的意外出血，降低网络延迟增加的风险，验证了该技术路径的可行性。未来需构建跨地域生理数据实时同步平台，推动远程手术动物麻醉流程标准化，为人体临床试验转化提供技术基础。

关键词: 远程机器人手术, 肾部分切除术, 动态麻醉管理, 肌松监测, 实验猪, 跨洲际手术

Abstract:

Objective To verify the technical feasibility and safety of partial nephrectomy in experimental pigs using a single-port endoscopic surgical robot in a transcontinental ultra-remote environment spanning 13 000 km with an average network delay of 204 ms, and to explore a dynamic combined anesthesia strategy that can effectively prevent intraoperative body movement in animals. Methods The research team used one experimental pig in Shanghai, China, and one in Orlando, the United States, and performed bidirectional remote surgery using the same model of single-port endoscopic surgical robot system. The anesthesia regimen included preoperative administration of 0.02 mg/kg dexmedetomidine hydrochloride and 0.05 mg/kg fentanyl citrate for combined sedation and analgesia. During remote surgery, according to the animal's reflex activity, pain response, and train-of-four stimulation (TOF) count results, vecuronium bromide was continuously infused at an initial rate of 0.04 mg·kg^-1·h^-1, and the dose was dynamically adjusted. Together with isoflurane inhalation anesthesia, the animal was maintained in a deep neuromuscular block state (TOF=0) to prevent intraoperative body movement. In addition, heart rate, blood pressure, muscle relaxation, and other indicators were monitored throughout the operation. Results Surgical operations were successfully performed at both sites, and the network delay remained stable at 202-208 ms. There was no data packet loss and no robot equipment failure. The vital signs of the experimental animal in Shanghai, China, remained stable, with zero body movement throughout the operation. Intraoperative blood loss was controllable, and no abnormal bleeding occurred. Conclusion In transcontinental ultra-remote robotic surgery with inherent network delay, a dynamically adjusted anesthesia strategy can effectively avoid accidental bleeding caused by animal body movement and reduce the risks associated with network latency, thereby verifying the feasibility of this technical approach. In the future, it will be necessary to build a real-time cross-regional physiological data synchronization platform, standardize anesthesia protocols for animals undergoing remote surgery, and provide a technical basis for clinical translation to human trials.

Key words: Robotic telesurgery, Partial nephrectomy, Dynamic anesthesia management, Muscle relaxation monitoring, Experimental pigs, Transcontinental surgery

中图分类号:

R614.2

刘意抒,王正,来娟,等. 动态麻醉保障跨洲际超远程机器人肾部分切除术动物零体动的可行性研究[J]. 实验动物与比较医学, 2026, 46(3): 397-407. DOI: 10.12300/j.issn.1674-5817.2025.143.

LIU Yishu,WANG Zheng,LAI Juan,et al. Feasibility Study of a Dynamic Anesthetic Strategy for Ensuring Zero Body Movement in Animals During Transcontinental Ultra-Remote Robotic Partial Nephrectomy[J]. Laboratory Animal and Comparative Medicine, 2026, 46(3): 397-407. DOI: 10.12300/j.issn.1674-5817.2025.143.

图/表 6

图 1 术锐手术机器人系统
注：A，术锐手术控制台；B，搭载3条蛇形机械臂和1个摄像头的患者手术平台；C，术锐单孔多通道套管；D，对偶连续体蛇形臂操作示意图。

Figure 1 The SHURUI robotic system
Note： A， SHURUI Surgeon Console； B， The patient-side surgical platform equipped with three snake-like robotic arms and one camera； C， SHURUI single-port multi-channel trocar； D， Schematic illustration of the operation of the dual-continuum snake-like robotic arm.

图 2 同步远程手术的视频截图
注：A，中国医师对美国实验猪实施手术；B，美国医师对中国实验猪实施手术；C，中国上海实验室医师的手术视野；D，美国奥兰多实验室医师的手术视野；E，美国奥兰多实验室的手术台外景；F，中国上海实验室的手术台外景。

Figure 2 Screenshot of the synchronized remote surgical video feed
Note： A， A Chinese surgeon operating on an American experimental pig；B， An American surgeon operating on a Chinese experimental pig； C， Surgical field view of the Shanghai lab， China； D， Surgical field view of the Orlando lab， America； E， External view of the operating table in the Orlando lab， America； F， External view of the operating table in the Shanghai lab， China.

表 1 反射活动及镇痛效果监测标准

Table 1 Reflex activity and analgesia monitoring criteria

指标 Indicator	刺激方法 Stimulation method	刺激反应 Response	记录标志 Record symbol
反射活动 Reflex activity	医用棉签轻触眼睑，观察眼睑反射	无反应	－
		反应迟钝	±
		出现躲闪、眨眼或闭眼	+
	注射器针头轻刺肛门，观察肛门反射	无收缩	－
		收缩微弱	±
		明显收缩	+
疼痛反应 Pain response	注射器针头轻刺后肢蹄冠部皮肤	后肢无收缩	－
		后肢收缩迟钝	±
		后肢明显收缩	+

表2 远程手术核心操作指标的对比

Table 2 Comparison of core operative metrics in telesurgery

指标 Indicator	中国上海实验室 Shanghai lab,China	美国奥兰多实验室 Orlando lab, America
操作医生位置 Surgeon location	中国上海	美国奥兰多
实验动物位置 Animal location	美国奥兰多	中国上海
网络延迟/ms Round-trip time/ms	204.30±0.75	203.20±0.76
丢包率/% Packet loss rate/%	0	0
并发症 Complication	无	无
手术机器人故障 Surgical robot malfunction	无	无
远程手术时长/min Telesurgery duration/min	29	40
热缺血时间/min Warm ischemia/min	0	18
主从控制权切换/次 Master-slave control switches/n	2	2
术中出血量/mL Blood loss /mL	50	25
动物意外体动/次 Accidental animal movement/n	0	0

表3 远程手术中动物麻醉深度的监测结果
注：TOF，四个成串刺激；±为反射/反应微弱；－为反射/反应消失。 T0～T4为监测时间点，其中T0为远程手术开始前，T1为手术开始后 10 min，T2为手术开始后20 min，T3为手术开始后30 min，T4为远程手术结束。

Table 3 Intraoperative anesthetic depth monitoring during telesurgery
Note： TOF，train-of-four； ± indicates weak/diminished reflexes or responses；－ indicates absent reflexes or responses. T0-T4 represent monitoring time points. T0， before telesurgery； T1 ，10 min after the start of telesurgery； T2 ，20 min after the start of telesurgery； T3，30 min after the start of telesurgery； T4， end of telesurgery.

检测指标 Indicator	T₀	T₁	T₂	T₃	T₄
眼睑反射 Eyelid reflex	－	－	－	－	－
肛门反射 Anal reflex	±	±	－	－	－
疼痛反应 Pain response	±	－	－	－	－
TOF计数 TOF count	3	2	1	0	0

图3 远程手术过程中实验动物生理指标的监测结果
注：A～E，远程手术过程中实验动物的心率（HR）、无创平均动脉压（NIMAP）、呼气末二氧化碳分压（P_etCO₂）、直肠体温（RCBT）和外周血氧饱和度（SpO₂）。T₀～T₄为监测时间点，其中T₀为远程手术开始前，T₁为手术开始后10 min，T₂为手术开始后20 min，T₃为手术开始后30 min，T₄为远程手术结束。

Figure 3 Intraoperative physiological monitoring of experimental animals during remote surgery
Note： A-E represent the heart rate， non-invasive mean arterial pressure，end-tidal carbon dioxide partial pressure， rectal core body temperature， and peripheral oxygen saturation. T₀-T₄ represent monitoring time points. T₀， before telesurgery； T₁， 10 min after the start of telesurgery； T₂， 20 min after the start of telesurgery； T₃， 30 min after the start of telesurgery； T₄， end of telesurgery.

参考文献 32

[1]	孙昊, 党建红, 李月明, 等. 5G远程机器人辅助单孔腹腔镜妇科手术1例应用实践[J]. 海军医学杂志, 2025, 46(3): 268-272. DOI: 10.3969/j.issn.1009-0754.2025.03.013 .
	SUN H, DANG J H, LI Y M, et al. 5G robot-assisted single-port laparoscopic gynecological telesurgery: a case report[J]. J Navy Med, 2025, 46(3): 268-272. DOI: 10.3969/j.issn.1009-0754.2025.03.013 .
[2]	LUPTON D, MASLEN S. Telemedicine and the senses: a review[J]. Sociol Health Illn, 2017, 39(8): 1557-1571. DOI: 10.1111/1467-9566.12617 .
[3]	GONDAL H, ABBAS T, CHOQUETTE H, et al. Patient and physician satisfaction with telemedicine in cancer care in Saskatchewan: a cross-sectional study[J]. Curr Oncol, 2022, 29(6): 3870-3880. DOI: 10.3390/curroncol29060309 .
[4]	陈劲果, 王之仕, 朱礼乐, 等. 国产手术机器人在泌尿外科中的应用与展望[J]. 机器人外科学杂志(中英文), 2025, 6(6): 916-921. DOI: 10.12180/j.issn.2096-7721.2025.06.007 .
	CHEN J G, WANG Z S, ZHU L L, et al. Application and prospects of domestic surgical robot in urology[J]. Chin J Rob Surg, 2025, 6(6): 916-921. DOI: 10.12180/j.issn.2096-7721.2025.06.007 .
[5]	CHIA D K A, SUDA K, HO W E, et al. Feasibility of long-range telesurgical robotic radical gastrectomy in a live porcine model[J]. Int J Surg, 2024, 110(12): 7720-7728. DOI: 10.1097/JS9.0000000000002151 .
[6]	MARESCAUX J, LEROY J, RUBINO F, et al. Transcontinental robot-assisted remote telesurgery: feasibility and potential applications[J]. Ann Surg, 2002, 235(4): 487-492. DOI: 10.1097/00000658-200204000-00005 .
[7]	王晓鹏, 王艳, 马云涛, 等. 5G远程机器人辅助袖状胃切除术首例报道[J]. 中国微创外科杂志, 2025, 25(1): 46-51. DOI: 10.3969/j.issn.1009-6604.2025.01.008 .
	WANG X P, WANG Y, MA Y T, et al. 5G remote robot-assisted sleeve gastrectomy: first case report[J]. Chin J Minim Invasive Surg, 2025, 25(1): 46-51. DOI: 10.3969/j.issn.1009-6604.2025.01.008 .
[8]	LI J M, YANG X C, CHU G D, et al. Application of improved robot-assisted laparoscopic telesurgery with 5G technology in urology[J]. Eur Urol, 2023, 83(1): 41-44. DOI: 10.1016/j.eururo.2022.06.018 .
[9]	代永鸿, 杨匡洋, 曾焰辉, 等. 5G远程机器人手术在骨盆骨折中的应用疗效分析[J]. 中国修复重建外科杂志, 2025, 39(4): 391-398. DOI: 10.7507/1002-1892.202501052 .
	DAI Y H, YANG K Y, ZENG Y H, et al. Effectiveness analysis of 5G remote robotic surgery in pelvic fracture treatment[J]. Chin J Repar Reconstr Surg, 2025, 39(4): 391-398. DOI: 10.7507/1002-1892.202501052 .
[10]	YE S Y, PENG D, ZHU L X, et al. 5G-remote radical prostatectomy under novel robotic systems: a prospective comparative cohort study with local surgeries[J]. Prostate Cancer Prostatic Dis, 2025. DOI: 10.1038/s41391-025-01004-4. DOI: 10.1038/s41391-025-01004-4 .
[11]	WANG Z, ZHANG C, WANG Y, et al. Single-port robotic telesurgery in urology: From preclinical validation to first clinical application[J]. Asian J Urol, 2025: S2214388225000 694. DOI: 10.1016/j.ajur.2025.06.002 .
[12]	张超, 王正, 张宗勤, 等. 国产单孔蛇形臂机器人手术系统在零缺血肾部分切除术中的初步应用[J]. 中华泌尿外科杂志, 2022, 43(2): 132-137. DOI: 10.3760/cma.j.cn112330-20211207-00633 .
	ZHANG C, WANG Z, ZHANG Z Q, et al. Study on the feasibility and safety of a novel single-port robotic surgical system in zero ischemic partial nephrectomy[J]. Chin J Urol, 2022, 43(2): 132-137. DOI: 10.3760/cma.j.cn112330-20211207-00633 .
[13]	国家市场监督管理总局, 国家标准化管理委员会. 实验动物安乐死指南: GB/T 39760—2021 [S]. 北京: 中国标准出版社, 2021.
	State Administration for Market Regulation, National Standardization Administration. Laboratory animal—Guide-lines for euthanasia: GB/T 39760—2021 [S]. Beijing: Standards Press of China, 2021.
[14]	BAILEY K, BRILEY J, DUFFEE L, et al. The American college of veterinary anesthesia and analgesia small animal anesthesia and sedation monitoring guidelines 2025[J]. Vet Anaesth Analg, 2025, 52(4): 377-385. DOI: 10.1016/j.vaa.2025.03.015 .
[15]	白建云, 贺峰, 贺婷, 等. 基于麻醉深度与肌松监测仪监测指导下的麻醉方式在经口腔前庭入路机器人辅助甲状腺切除患者中的应用[J]. 机器人外科学杂志(中英文), 2025, 6(4): 596-600. DOI: 10.12180/j.issn.2096-7721.2025.04.014 .
	BAI J Y, HE F, HE T, et al. Application of anesthesia guided by anesthetic depth and neuromuscular monitoring in patients undergoing transoral vestibular robot-assisted thyroidectomy[J]. Chin J Rob Surg, 2025, 6(4): 596-600. DOI: 10.12180/j.issn.2096-7721.2025.04.014 .
[16]	ALI H H, UTTING J E, GRAY T C. Quantitative assessment of residual antidepolarizing block (part Ⅰ)[J]. Br J Anaesth, 1971, 43(5): 473-477. DOI: 10.1093/bja/43.5.473 .
[17]	LIU H, LV Z W, ZHANG G, et al. Molecular understanding and clinical aspects of tumor-associated macrophages in the immunotherapy of renal cell carcinoma[J]. J Exp Clin Cancer Res, 2024, 43(1): 242. DOI: 10.1186/s13046-024-03164-y .
[18]	ROSE T L, KIM W Y. Renal cell carcinoma: a review[J]. JAMA, 2024, 332(12): 1001-1010. DOI: 10.1001/jama.2024.12848 .
[19]	PECORARO A, ROSIELLO G, LUZZAGO S, et al. Small renal masses with tumor size 0 to 2 cm: a SEER-based study and validation of NCCN guidelines[J]. J Natl Compr Canc Netw, 2020, 18(10): 1340-1347. DOI: 10.6004/jnccn.2020.7577 .
[20]	ZEUSCHNER P, GREGULETZ L, MEYER I, et al. Open versus robot-assisted partial nephrectomy: a longitudinal comparison of 880 patients over 10 years[J]. Int J Med Robot, 2021, 17(1): 1-8. DOI: 10.1002/rcs.2167 .
[21]	QU H C, WANG K, HU B. Meta-analysis of clinical outcomes of robot-assisted partial nephrectomy and classical open partial nephrectomy[J]. Int J Surg, 2024, 110(10): 6268-6281. DOI: 10.1097/JS9.0000000000001324 .
[22]	韩松辰, 宋宇轩, 戴翔, 等. 热缺血时间对腹腔镜肾部分切除术后肾功能的影响[J]. 中华泌尿外科杂志, 2022, 43(5): 350-354. DOI: 10.3760/cma.j.cn112330-20220311-00110 .
	HAN S C, SONG Y X, DAI X, et al. Impact of warm ischemia time during partial nephrectomy on laparoscopic post-operative renal function[J]. Chin J Urol, 2022, 43(5): 350-354. DOI: 10.3760/cma.j.cn112330-20220311-00110 .
[23]	朱艳超. 热缺血时间对后腹腔镜肾部分切除术患者肾功能的影响[J]. 现代诊断与治疗, 2018, 29(22): 3678-3679. DOI: 10.3969/j.issn.1001-8174.2018.22.050 .
	ZHU Y C. Effect of warm ischemia time on renal function in patients undergoing retroperitoneal laparoscopic partial nephrectomy[J]. Mod Diagn Treat, 2018, 29(22): 3678-3679. DOI: 10.3969/j.issn.1001-8174.2018.22.050 .
[24]	中国抗癌协会泌尿男生殖系肿瘤专业委员会微创学组. 中国肾肿瘤腹腔镜及机器人肾部分切除术专家共识[J]. 泌尿外科杂志(电子版), 2021, 13(4): 1-5, 9. DOI: 10.3969/j.issn.1674-7410.2021.04.001 .
	China Anti-Cancer Association GU Society Minimally Invasive Surgery Section. Chinese expert consensus on laparoscopic partial nephrectomy and robotic assisted laparoscopic partial nephrectomy for renal neoplasms[J]. J Urol Clin (Electron Version), 2021, 13(4): 1-5, 9. DOI: 10.3969/j.issn.1674-7410.2021.04.001 .
[25]	GRECO F, AUTORINO R, ALTIERI V, et al. Ischemia techniques in nephron-sparing surgery: a systematic review and meta-analysis of surgical, oncological, and functional outcomes[J]. Eur Urol, 2019, 75(3): 477-491. DOI: 10.1016/j.eururo.2018.10.005 .
[26]	WANG Y, AI Q, SHI T P, et al. Influence of network latency and bandwidth on robot-assisted laparoscopic telesurgery: a pre-clinical experiment[J]. Chin Med J, 2025, 138(3): 325-331. DOI: 10.1097/CM9.0000000000003257 .
[27]	OH S S, NARVER H L. Mouse and rat anesthesia and analgesia[J]. Curr Protoc, 2024, 4(2): 1-42. DOI: 10.1002/cpz1.995 .
[28]	REDONDO J I, OTERO P E, MARTÍNEZ-TABOADA F, et al. Anaesthetic mortality in dogs: a worldwide analysis and risk assessment[J]. Vet Rec, 2024, 195(1): 1-13. DOI: 10.1002/vetr. 3604 .
[29]	GOSWAMI U, RAHMAN M M, TENG J F, et al. Structural interplay of anesthetics and paralytics on muscle nicotinic receptors[J]. Nat Commun, 2023, 14(1): 1-10. DOI: 10.1038/s41467-023-38827-5 .
[30]	QIU G L, WANG P, RAO J, et al. Dexmedetomidine inhibits paraventricular corticotropin-releasing hormone neurons that attenuate acute stress-induced anxiety-like behavior in mice[J]. Anesthesiology, 2024, 140(6): 1134-1152. DOI: 10.1097/ALN.0000000000004982 .
[31]	BARNES K, MCNAIR N A, HARRIS J A, et al. In anticipation of pain: expectancy modulates corticospinal excitability, auto-nomic response, and pain perception[J]. Pain, 2021, 162(8): 2287-2296. DOI: 10.1097/j.pain.0000000000002222 .
[32]	BAILEY K, BRILEY J, DUFFEE L, et al. The American college of veterinary anesthesia and analgesia small animal anesthesia and sedation monitoring guidelines 2025[J]. Vet Anaesth Analg, 2025, 52(4): 377-385. DOI: 10.1016/j.vaa.2025.03.015 .

动态麻醉保障跨洲际超远程机器人肾部分切除术动物零体动的可行性研究

Feasibility Study of a Dynamic Anesthetic Strategy for Ensuring Zero Body Movement in Animals During Transcontinental Ultra-Remote Robotic Partial Nephrectomy

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