Fernandes E, Giulianotti P C
Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA.
J Hepatobiliary Pancreat Sci. 2013 Aug;20(6):583-9. doi: 10.1007/s00534-013-0615-1.
BACKGROUND: Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. METHODS: As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. RESULTS: Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. CONCLUSION: Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short- and long-term outcomes seem to be similar to the ones achieved in open surgery.
背景:胰腺手术是微创手术中一项具有挑战性的应用。由于手术技术复杂,需要沿着腹部主要血管进行解剖,以及涉及胆管、胰腺和肠道吻合的精细重建,关于腹腔镜胰腺手术的报道很少。然而,随着机器人辅助手术的出现,腕式器械带来的更高灵活性、改进的三维视野以及对外科医生动作的计算机过滤,使微创胰腺手术进入了一个新时代。 方法:作为全球进行机器人辅助胰腺手术数量最多的手术团队,我们回顾了微创机器人辅助胰腺手术的最新技术水平。考虑了所有主要机器人辅助胰腺手术系列的临床结果。 结果:已发表的主要胰腺手术系列的初步报告显示出令人鼓舞的结果,其发病率和死亡率与开放手术相当。关于癌症生存率的初步数据似乎也与开放手术系列相似。 结论:机器人辅助胰腺手术对所有胰腺疾病都是安全可行的。胰腺手术的复杂性使其需要在专门的中心进行,在这些中心,短期和长期结果似乎与开放手术所取得的结果相似。