Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Division of HBP Surgery, Department of Surgery, Cha Bundang Medical Center, Bundang, South Korea.
J Gastrointest Surg. 2020 Sep;24(9):2015-2020. doi: 10.1007/s11605-019-04330-w. Epub 2019 Aug 6.
A reduced-port approach including single-site surgery has been used for distal pancreatectomy. However, triangulation is difficult in reduced-port laparoscopic distal pancreatectomy, and instrument crowding, and collision may occur, so this approach has not been widely used. Recently, an innovative technique for distal pancreatectomy using a robotic single-site surgical system was introduced. Herein, we evaluate the safety and feasibility of this technique.
Twenty-seven patients with a pancreatic tail mass underwent robotic single-site plus one-port distal pancreatectomy at six centers. We collected clinicopathologic data and evaluated the short-term perioperative outcomes of robotic single-site plus one-port distal pancreatectomy.
We evaluated 26 patients who underwent robotic single-site plus one-port distal pancreatectomy excluding one patient who needed more ports because of fatty abdomen. The mean age and body mass index were 47.3 years (range 21-74) and 22.6 kg/m (range 15.8-28.8), respectively. The most common pathologic diagnosis was solid papillary neoplasm followed by a neuroendocrine tumor. The mean operating time was 201 min. The mean length of hospital stay after surgery was 7 days (range 4-10). The rate of spleen preservation was 34.6% (9/26). Six patients had postoperative pancreatic fistula (POPF) grade A, and no patients had POPF grade B or C. Only one patient had class II morbidity.
Robotic single-site plus one-port distal pancreatectomy is safe and feasible in terms of short-term outcomes. This technique could be performed in select cases to expand the surgical boundaries of the robotic single-site platform. Further studies are needed with more cases to investigate long-term outcomes.
包括单部位手术在内的经端口减少的方法已用于胰体尾部切除术。然而，经端口减少的腹腔镜胰体尾部切除术的三角操作较为困难，且可能发生器械拥挤和碰撞，因此该方法尚未得到广泛应用。最近，引入了一种使用机器人单部位手术系统进行胰体尾部切除术的创新技术。在此，我们评估该技术的安全性和可行性。
六个中心的 27 例胰腺尾部肿块患者接受了机器人单部位加单端口胰体尾部切除术。我们收集了临床病理数据，并评估了机器人单部位加单端口胰体尾部切除术的短期围手术期结果。
我们评估了 26 例接受机器人单部位加单端口胰体尾部切除术的患者，其中 1 例因腹部脂肪较多而需要更多端口。患者的平均年龄和体重指数分别为 47.3 岁（范围 21-74 岁）和 22.6 kg/m²（范围 15.8-28.8 kg/m²）。最常见的病理诊断是实性乳头状肿瘤，其次是神经内分泌肿瘤。手术的平均时间为 201 分钟。术后住院时间的平均长度为 7 天（范围 4-10 天）。保脾率为 34.6%（9/26）。6 例患者发生术后胰瘘（POPF）A级，无患者发生 POPF B 级或 C 级。仅 1 例患者发生 II 级并发症。
从短期结果来看，机器人单部位加单端口胰体尾部切除术是安全可行的。在选择病例的情况下，该技术可以扩展机器人单部位平台的手术范围。需要更多病例进行进一步研究，以调查长期结果。
