Zureikat Amer H, Nguyen Trang, Boone Brian A, Wijkstrom Martin, Hogg Melissa E, Humar Abhinav, Zeh Herbert
Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 418, Pittsburgh, PA, 15232, USA,
Surg Endosc. 2015 Jan;29(1):176-83. doi: 10.1007/s00464-014-3656-x. Epub 2014 Jul 9.
Total pancreatectomy (TP) is a morbid but sometimes necessary operation. Robotic TP is not often reported but may harbor some advantages compared to the open approach. This manuscript details a single institution's outcomes and technique of robotic TP. An accompanying video demonstrates a robotic TP with auto islet cell transplantation (IAT) in which (1) the arterial blood supply and venous drainage are kept intact until the last step of the TP to minimize warm ischemia time and (2) extirpation of the entire pancreas is performed without dividing the pancreatic neck to maximize islet recovery.
This study is a retrospective review of a prospective database of perioperative outcomes of all consecutive robotic TPs at a single institution. This included a single robotic TP with IAT performed on a twenty-year-old patient with chronic pancreatitis.
Between 2010 and January 2014, ten robotic TPs were performed (7 males, mean age 58 years), one of which included an IAT. Median body mass index was 28. Indications were intraductal papillary mucinous neoplasms (6), pancreatic adenocarcinoma (1), and chronic pancreatitis (3). The median operative time was 560 min with a median estimated blood loss of 650 ml. One case was converted to laparotomy. Ninety days mortality and Clavien III-IV complication rate were 0 and 20 %, respectively. The average length of stay was 10 ± 3 days, with only 1 readmission within 90 days. The single TP and IAT were completed successfully without conversion, and were achieved without division of the pancreatic neck thereby maintaining vascular inflow to an entire specimen up until extraction.
This represents the largest series of robotic TP, demonstrating its safety and feasibility. Additionally, TP and IAT using the technique described above can be recapitulated using the robotic approach.
全胰切除术（TP）是一种创伤较大但有时又必不可少的手术。机器人辅助全胰切除术的报道并不常见，但与开放手术相比可能具有一些优势。本文详细介绍了单一机构开展机器人辅助全胰切除术的结果及技术。随附视频展示了一例机器人辅助全胰切除术联合自体胰岛细胞移植（IAT），其中（1）在全胰切除术的最后一步之前保持动脉血供和静脉引流完整，以尽量减少热缺血时间；（2）在不切断胰颈的情况下切除整个胰腺，以最大限度地提高胰岛回收率。
本研究是对单一机构所有连续进行的机器人辅助全胰切除术围手术期结果的前瞻性数据库进行的回顾性分析。其中包括对一名20岁慢性胰腺炎患者实施的一例机器人辅助全胰切除术联合自体胰岛细胞移植。
2010年至2014年1月，共实施了10例机器人辅助全胰切除术（7例男性，平均年龄58岁），其中1例包括自体胰岛细胞移植。中位体重指数为28。手术指征为导管内乳头状黏液性肿瘤（6例）、胰腺腺癌（1例）和慢性胰腺炎（3例）。中位手术时间为560分钟，中位估计失血量为650毫升。1例中转开腹手术。90天死亡率和Clavien III - IV级并发症发生率分别为0和20%。平均住院时间为10±3天，90天内仅1例再次入院。单一的全胰切除术联合自体胰岛细胞移植成功完成，未中转，且在不切断胰颈的情况下完成，从而在取出标本前保持整个标本的血管流入。
这是最大规模的机器人辅助全胰切除术系列报道，证明了其安全性和可行性。此外，使用上述技术的全胰切除术和自体胰岛细胞移植可以通过机器人手术方法再现。
