Giulianotti Pier C, Sbrana Fabio, Bianco Francesco M, Addeo Pietro, Caravaglios Giuseppe
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
J Laparoendosc Adv Surg Tech A. 2010 Mar;20(2):135-9. doi: 10.1089/lap.2009.0296.
Middle pancreatectomy has been accepted as a valid surgical alternative to more extensive standard resections for the treatment of benign central pancreatic tumors. In this article, we describe a new minimally invasive approach to this procedure, using a robot-assisted laparoscopic technique.
From May 2004 to October 2005, 3 patients (2 female and 1 male), with a mean age of 52 years (range, 44-68), underwent robot-assisted laparoscopic middle pancreatectomies at the Department of General Surgery of Misericordia Hospital in Grosseto, Italy. Two of the patients had symptomatic serous cystadenomas, and 1 patient had a mucinous cystadenoma, which was discovered incidentally. The da Vinci((R)) Surgical System (Intuitive Surgical, Sunnyvale, CA) was used to perform the main steps of the intervention. All patients underwent a pancreaticogastrostomy for pancreaticoenteric reconstruction to the distal stump.
The mean operative time was 320 minutes (range, 270-380). Mean blood loss was 233 mL (range, 100-400). There were no mortalities. One patient developed a postoperative pancreatic fistula, which was managed conservatively. The postoperative hospital stay was 9 days for 2 patients and 27 days for the third patient. No endocrine or exocrine deficiencies were observed in the patients during a mean follow-up of 44 months (range, 38-48).
Robot-assisted laparoscopic middle pancreatectomy presents an interesting, less-invasive option for resection of benign tumors of the neck and proximal body of the pancreas. In benign disease, it allows for the preservation of functional pancreatic parenchyma and, subsequently, reduced operative trauma.
对于良性胰腺中央肿瘤的治疗，中段胰腺切除术已被公认为是一种有效的手术方式，可替代更为广泛的标准切除术。在本文中，我们描述了一种采用机器人辅助腹腔镜技术的该手术新的微创方法。
2004年5月至2005年10月，3例患者（2例女性，1例男性），平均年龄52岁（范围44 - 68岁），在意大利格罗塞托米塞里科迪亚医院普通外科接受了机器人辅助腹腔镜中段胰腺切除术。其中2例患者患有有症状的浆液性囊腺瘤，1例患者患有黏液性囊腺瘤，为偶然发现。使用达芬奇手术系统（直观外科公司，加利福尼亚州森尼韦尔市）进行干预的主要步骤。所有患者均行胰胃吻合术以重建胰腺与远端残端的消化道连续性。
平均手术时间为320分钟（范围270 - 380分钟）。平均失血量为233毫升（范围100 - 400毫升）。无死亡病例。1例患者出现术后胰瘘，经保守治疗。2例患者术后住院时间为9天，第3例患者为27天。在平均44个月（范围38 - 48个月）的随访中，未观察到患者有内分泌或外分泌功能不足。
机器人辅助腹腔镜中段胰腺切除术为胰腺颈部和近端体部良性肿瘤的切除提供了一种有趣的、侵入性较小的选择。对于良性疾病，它能够保留功能性胰腺实质，从而减少手术创伤。
