Lee Jin Woo, Choi Sung Hoon, Chon Hong Jae, Kim Dae Jung, Kim Gwangil, Kwon Chang Il, Ko Kwang Hyun
Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Medical oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Int J Med Robot. 2019 Jun;15(3):e1979. doi: 10.1002/rcs.1979. Epub 2019 Jan 8.
The adoption of minimally invasive surgery for transduodenal ampullectomy has been slow because of special characteristics and complexity of this procedure.
Six patients underwent robotic transduodenal ampullectomy. We employed novel methods to facilitate exposure of the ampulla.
All patients completed robotic transduodenal ampullectomy, but one patient was immediately converted to robotic pancreaticoduodenectomy because of presence of invasive carcinoma on frozen biopsy. The final pathologic report revealed high-grade dysplasia in four patients, low-grade dyplasia in one, and T2N0 in one patient who converted to pancreaticoduodenectomy. There was no immediate postoperative complication or mortality. One patient was readmitted after 3 months because of stricture of the bile duct outlet. There was no recurrence over a median follow-up period of 20 months.
An appropriate combination of patient positioning and retraction method helps the robot surgical system to provide competent performance for sophisticated and precise manipulation of ampullary lesions.
由于经十二指肠壶腹切除术的特殊性质和复杂性，其微创手术的应用进展缓慢。
6例患者接受了机器人辅助经十二指肠壶腹切除术。我们采用了新的方法来促进壶腹的暴露。
所有患者均完成了机器人辅助经十二指肠壶腹切除术，但1例患者因术中冰冻活检发现浸润性癌而立即转为机器人辅助胰十二指肠切除术。最终病理报告显示，4例患者为高级别异型增生，1例为低级别异型增生，1例转为胰十二指肠切除术的患者为T2N0。术后无即刻并发症或死亡。1例患者在3个月后因胆管出口狭窄再次入院。中位随访20个月无复发。
合适的患者体位和牵拉方法相结合，有助于机器人手术系统对壶腹病变进行精细、精确的操作。
