Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy.
Br J Surg. 2013 Jun;100(7):917-25. doi: 10.1002/bjs.9135.
Laparoscopic pancreaticoduodenectomy is feasible, but requires adaptations to established surgical techniques. The improved dexterity offered by robotic assistance provides the opportunity to see whether laparoscopic pancreaticoduodenectomy can be performed safely when faithfully reproducing the open operation.
Patients were selected for robotic pancreaticoduodenectomy when generally suitable for laparoscopy. Obese patients were excluded, and those with pancreatic cancer were highly selected. A prospectively designed database was used for data collection and analysis.
Of 238 patients undergoing pancreaticoduodenectomy, 34 (14·3 per cent) were operated on robotically. No procedure was converted to conventional laparoscopy or open surgery, despite three patients requiring segmental resection of the superior mesenteric/portal vein and reconstruction. The mean duration of operation was 597 (range 420-960) min. The mean number of lymph nodes retrieved and analysed from patients with neoplasia was 32 (range 15-76). Four patients required blood transfusions and five developed postoperative complications exceeding Clavien-Dindo grade II. There were four grade B pancreatic fistulas. One patient died on postoperative day 40. Excess mean operative cost compared with open resection was €6193.
Selected patients can safely undergo robotic pancreaticoduodenectomy. The main downsides are high costs and prolonged operating times compared with open resection.
腹腔镜胰十二指肠切除术是可行的，但需要对既定的手术技术进行调整。机器人辅助提供了更好的灵活性，使我们有机会在忠实地复制开放手术的情况下，观察腹腔镜胰十二指肠切除术是否可以安全进行。
当患者一般适合接受腹腔镜手术时，会选择接受机器人胰十二指肠切除术。肥胖患者被排除在外，而且胰腺癌患者的选择非常严格。使用前瞻性设计的数据库来收集和分析数据。
在接受胰十二指肠切除术的 238 名患者中，有 34 名（14.3%）接受了机器人手术。尽管有 3 名患者需要肠系膜上/门静脉节段切除和重建，但没有一个手术转换为传统腹腔镜或开放手术。手术平均时间为 597（420-960）分钟。有肿瘤的患者平均从淋巴结中取出并分析的淋巴结数量为 32 个（15-76 个）。有 4 名患者需要输血，5 名患者发生超过 Clavien-Dindo Ⅱ级的术后并发症。有 4 例 B 级胰瘘。1 名患者在术后第 40 天死亡。与开放性切除相比，平均手术费用增加了 6193 欧元。
选择合适的患者可以安全地接受机器人胰十二指肠切除术。与开放性切除相比，其主要缺点是成本较高和手术时间延长。
