Morelli Luca, Furbetta Niccolò, Gianardi Desirée, Palmeri Matteo, Di Franco Gregorio, Bianchini Matteo, Stefanini Gianni, Guadagni Simone, Di Candio Giulio
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy.
World J Clin Cases. 2019 Jun 26;7(12):1461-1466. doi: 10.12998/wjcc.v7.i12.1461.
Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi.
A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic trans-gastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)scan using the TilePro™ function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection.
In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
包裹性胰腺坏死（WOPN）是急性胰腺炎的一种晚期并发症。WOPN的治疗取决于其位置和患者症状。经胃引流及清创术是部分选定患者重要的手术治疗选择。达芬奇手术系统的研发旨在使手术操作简便、微创且快速，即便在具有挑战性的腹部手术中亦是如此。我们在此呈现一例使用达芬奇Xi系统经胃机器人引流治疗WOPN的病例。
一名63岁男性因急性坏死性胰腺炎发作被转诊至我院。急性发作6周后，患者出现一个包裹性大量液体积聚，伴有广泛的胰腺坏死，导致胃肠道梗阻。患者接受了使用达芬奇Xi平台进行的经胃机器人引流及WOPN清创术。首先，在术中超声（US）扫描使用TilePro™功能的引导下，进行理想的前位胃切开术。然后，通过胃切开术，再次在US引导下确定胃后壁上最佳的引流位置。使用带有血管钉仓的新型EndoWrist吻合器进行胃后壁与包裹性坏死壁之间的吻合。通过吻合口对腔隙进行清创和冲洗。最后，关闭前位胃切开处并进行胆囊切除术。术后过程顺利，术后计算机断层扫描显示液体积聚消失。
在选定的WOPN病例中，达芬奇手术系统可安全地用作有效的手术治疗选择。
