Aselmann H, Egberts J-H, Hinz S, Jünemann K-P, Becker T
Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland.
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland.
Zentralbl Chir. 2016 Apr;141(2):139-41. doi: 10.1055/s-0035-1568423. Epub 2016 Apr 13.
The surgical treatment of pancreatic head tumours is one of the most complex procedures in general surgery. In contrast to colorectal surgery, minimally-invasive techniques are not very commonly applied in pancreatic surgery. Both the delicate dissection along peri- and retropancreatic vessels and the extrahepatic bile ducts and subsequent reconstruction are very demanding with rigid standard laparoscopic instruments. The 4-arm robotic surgery system with angled instruments, unidirectional movement of instruments with adjustable transmission, tremor elimination and a stable, surgeon-controlled 3D-HD view is a promising platform to overcome the limitations of standard laparoscopic surgery regarding precise dissection and reconstruction in pancreatic surgery.
Pancreatic head resection for mixed-type IPMN of the pancreatic head.
Robot-assisted, minimally-invasive pylorus-preserving pancreaticoduodenectomy (Kausch-Whipple procedure).
The robotic approach is particularly suited for complex procedures such as pylorus-preserving pancreatic head resections. The fully robotic Kausch-Whipple procedure is technically feasible and safe. The advantages of the robotic system are apparent in the delicate dissection near vascular structures, in lymph node dissection, the precise dissection of the uncinate process and, especially, bile duct and pancreatic anastomosis.
胰头肿瘤的外科治疗是普通外科中最复杂的手术之一。与结直肠手术不同，微创技术在胰腺手术中应用并不普遍。使用刚性标准腹腔镜器械对胰周和胰后血管以及肝外胆管进行精细解剖并随后进行重建要求极高。具有成角器械、器械单向运动且传动可调节、震颤消除以及稳定的、由外科医生控制的3D高清视野的四臂机器人手术系统是一个很有前景的平台，可克服标准腹腔镜手术在胰腺手术精确解剖和重建方面的局限性。
胰头混合型导管内乳头状黏液性肿瘤（IPMN）的胰头切除术。
机器人辅助的微创保留幽门胰十二指肠切除术（考施-惠普尔手术）。
机器人手术方法特别适用于诸如保留幽门胰头切除术等复杂手术。全机器人考施-惠普尔手术在技术上是可行且安全的。机器人系统的优势在血管结构附近的精细解剖、淋巴结清扫、钩突的精确解剖，尤其是胆管和胰腺吻合方面显而易见。
