Memeo R, De Blasi V, Perotto O, Mutter D, Marescaux J, Pessaux P
Unité de chirurgie Hépato-biliaire et pancréatique, service de chirurgie digestive et endocrinienne, Nouvel Hôpital Civil, Strasbourg, France.
IRCAD, Institut de recherche contre les cancers de l'appareil digestif, Strasbourg, France.
Ann Surg Oncol. 2016 Dec;23(Suppl 5):968. doi: 10.1245/s10434-016-5421-y. Epub 2016 Jul 26.
An expert consensus meeting had defined the standard lymphadenectomy during pancreatoduodenectomy for an adenocarcinoma of the head of the pancreas. There is a controversy regarding the possibility to perform this optimal lymphadenectomy by minimally invasive approach.
The patient was a 68-year-old man with the diagnosis of an adenocarcinoma of the head of the pancreas. The 3D reconstructions evidenced the existence of a right hepatic artery.
The patient was positioned in the French position with the assistant between the legs and the robot at the head. Five trocars were used; the camera was introduced through the umbilicus trocar. The operation began with a peritoneal and liver exploration, and with an inter-aortico-caval picking. Because lymph nodes were noninvaded, pancreatoduodenectomy was decided with the first dissection of the superior mesenteric artery helped with a hanging maneuver. The right hepatic artery was dissected. Each structure of the hepatic pedicle was skeletonized. The camera was switched to the right side. The first jejunal loop was divided with a stapler. The specimen was totally mobilized en bloc, freed from the portal vascular axis with a dissection of the right border of the coeliac trunk. The pancreas was divided. At the end of the dissection, the different arterial and venous structures were skeletonized with a resection of the lymph node group 5-6-8-12-13-14-17. Pathology confirmed R0 resection for a well-differentiated pancreatic adenocarcinoma graded pT3N1 (5/20).
Robotic pancreatoduodenectomy could be performed with an optimal standard lymphadenectomy as recommended by the expert consensus.
一次专家共识会议确定了胰头腺癌胰十二指肠切除术中标准淋巴结清扫术的范围。对于能否通过微创方法进行这种最佳淋巴结清扫术存在争议。
该患者为一名68岁男性，诊断为胰头腺癌。三维重建显示存在右肝动脉。
患者采用法国体位，助手位于双腿之间，机器人位于头部位置。使用了5个套管针；通过脐部套管针插入摄像头。手术首先进行腹膜和肝脏探查，并进行主动脉-腔静脉间淋巴结摘取。由于淋巴结未受侵犯，决定行胰十二指肠切除术，首先在悬吊操作辅助下解剖肠系膜上动脉。解剖右肝动脉。肝蒂的每个结构均进行骨骼化处理。将摄像头切换至右侧。用吻合器离断第一段空肠袢。将标本整块完全游离，通过解剖腹腔干右缘使其与门静脉血管轴分离。切断胰腺。在解剖结束时，通过切除第5、6、8、12、13、14、17组淋巴结，使不同的动静脉结构骨骼化。病理证实为R0切除，为高分化胰腺腺癌，分级为pT3N1（5/20）。
机器人胰十二指肠切除术可按照专家共识推荐的方式进行最佳标准淋巴结清扫。
