Marino Marco, Gulotta Gaspare, Komorowski Andrzej L
1Department of Emergency and General Surgery, P. Giaccone Hospital, University of Palermo. Giuffrè L. str. 5, 90127 Palermo, Italy.
2Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology Cancer Centre, Garncarska str. 11, 31-115 Kraków, Poland.
Indian J Surg. 2018 Apr;80(2):118-122. doi: 10.1007/s12262-017-1628-9. Epub 2017 Mar 20.
Robotic surgery can help to overcome some technical limitations of laparoscopic pancreaticoduodenectomy thanks to EndoWrist instrumentations and the 3D view. Despite the potential benefits, its employment is still low and controversial. We focused on some important technical details crucial for a safe robotic pancreatectomy. After performing 52 robotic pancreatic resections that included 10 pancreatoduodenectomies, the authors describe their technique. The review of literature on robotic and laparoscopic duodenopancreatectomy is also performed in order to evaluate possible benefits of the robotic platform. We describe the step-by-step surgical procedure, analyzing all possible troubleshooting occurring in an initial center experience. The estimated blood loss as well as the length of stay was reduced by the robotic approach. We did not observe any significant increase of pancreatic fistula rate and all other postoperative complications despite our initial learning curve. Robotic pancreatoduodenectomy is a technically advanced procedure that requires important laparoscopic and robotic skills but it shows to be safe, feasible with some clear advantages in the bleeding control and in the reconstructive phase of the procedure.
得益于EndoWrist器械和三维视野，机器人手术有助于克服腹腔镜胰十二指肠切除术的一些技术局限。尽管有潜在益处，但其应用率仍然较低且存在争议。我们聚焦于安全的机器人胰腺切除术的一些重要技术细节。在完成52例机器人胰腺切除术（包括10例胰十二指肠切除术）后，作者描述了他们的技术。还对机器人和腹腔镜十二指肠胰腺切除术的文献进行了综述，以评估机器人平台可能带来的益处。我们描述了逐步的手术过程，分析了在一个初始中心经验中出现的所有可能的故障排除情况。机器人手术方法减少了估计失血量和住院时间。尽管处于初始学习曲线阶段，但我们并未观察到胰瘘发生率及所有其他术后并发症有任何显著增加。机器人胰十二指肠切除术是一项技术先进的手术，需要重要的腹腔镜和机器人手术技能，但它在手术的出血控制和重建阶段显示出安全、可行且具有一些明显优势。
