Hagendoorn Jeroen, Nota Carolijn L M A, Borel Rinkes Inne H M, Molenaar I Quintus
Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands.
Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
Surg Oncol. 2018 Dec;27(4):635-636. doi: 10.1016/j.suronc.2018.07.013. Epub 2018 Jul 25.
Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [1]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open surgery [2], it remains to be determined whether the pediatric population may potentially benefit from this minimally invasive procedure. Here we present, for the first time, a video of setup and surgical technique of robotic pancreatoduodenectomy in a child.
A 10-year-old girl presented with complaints of fullness and abdominal pain in the upper quadrants. Investigations including a diffusion-weighted, pancreatic MR scan suggested the diagnosis of solid pseudopapillary tumor (Frantz's tumor). The patient was considered for robotic pancreatoduodenectomy.
After anesthesia, the patient was placed supine on a split-leg table. Trocar placement was adjusted to accommodate the child's length and body weight, according to pre-operatively calculated positions that would allow for maximum working space and minimize inadvertent collision between the robotic arms. The da Vinci Si surgical robot was positioned in-line towards the surgical target and all four robotic arms were docked, while two additional laparoscopic ports were placed for tableside assistance. After standard pancreatoduodenectomy, a conventional loop reconstruction was performed including an end-to-side pancreaticojejunostomy with duct-to-mucosa technique and stapled side-to-side gastrojejunostomy. We suggest that in this patient group, pylorus preserving pancreatoduodenectomy with end-to-side duodenojejunostomy may be a suitable alternative. Postoperative recovery was complicated by delayed gastric emptying but otherwise unremarkable. Hospital length of stay was 12 days. Final pathology demonstrated a solid pseudopapillary tumor with negative surgical margins.
This case illustrates the feasibility of robotic pancreatoduodenectomy in children. Essential elements of this procedure are a well-running robotic pancreatic surgery program as well as careful preoperative port placement planning.
儿童胰十二指肠切除术（惠普尔手术）虽很少应用，但切实可行。然而，在几种儿童胰腺恶性肿瘤中，它可能是唯一的治愈策略[1]。随着机器人胰十二指肠切除术的出现，其至少在临床上等同于开放手术[2]，儿童群体是否可能从这种微创手术中获益仍有待确定。在此，我们首次展示了儿童机器人胰十二指肠切除术的手术设置和技术视频。
一名10岁女孩主诉上腹部饱胀和腹痛。包括弥散加权胰腺磁共振扫描在内的检查提示诊断为实性假乳头状瘤（弗兰茨瘤）。该患者被考虑行机器人胰十二指肠切除术。
麻醉后，患者仰卧于分腿手术台上。根据术前计算的位置调整套管针的放置，以适应儿童的身高和体重，这些位置应能提供最大的工作空间并尽量减少机器人手臂之间的意外碰撞。达芬奇Si手术机器人沿直线朝向手术目标定位，所有四个机器人手臂对接，同时额外放置两个腹腔镜端口用于床边辅助。在标准胰十二指肠切除术后，进行了传统的吻合重建，包括采用导管对黏膜技术的端侧胰肠吻合术和吻合器侧侧胃空肠吻合术。我们认为，在该患者群体中，保留幽门的胰十二指肠切除术加端侧十二指肠空肠吻合术可能是一种合适的替代方案。术后恢复因胃排空延迟而复杂化，但其他方面并无异常。住院时间为12天。最终病理显示为实性假乳头状瘤，手术切缘阴性。
该病例说明了儿童机器人胰十二指肠切除术的可行性。该手术的关键要素是运行良好的机器人胰腺手术程序以及术前仔细的端口放置规划。
