Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese Medical School, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
Surg Endosc. 2021 Apr;35(4):1703-1712. doi: 10.1007/s00464-020-07557-w. Epub 2020 Apr 15.
Minimally invasive surgery is beneficial for pancreatic surgery, and the indication has been expanded to pancreatoduodenectomy (PD). The aim of this study was to share our experiences with hybrid PD in laparoscopic and robotic surgery.
Sixty-four patients underwent hybrid PD in which specimen resection and gastrojejunostomy were performed through the laparoscopic route and pancreatojejunostomy and hepaticojejunostomy were performed via a robotic approach by the same surgeon at a single institution between July 2016 and June 2019. The primary endpoint was complications; secondary endpoints were operative time (OT), the length of hospital stay, and blood loss. The data for the patients were retrospectively obtained from electrical medical records.
All patients underwent surgery with the hybrid procedure. The mean OTs and estimated blood loss (EBL) were 309.7 ± 77.6 min (range 17-620 min), 160 ± 31.7 mL (range 50-800 mL). The mean number of lymph nodes retrieved was 7.3 ± 6.7 (range 0-37), and that among 45 malignant cases was 8.42 ± 6.7 (range 1-37). The average length of postoperative stay in the hospital was 11.14 ± 7.03 days (range 6-47 days). Clinically relevant postoperative pancreatic fistulas (POPFs) occurred in 39 (60.9%) cases, and most were biochemical leak POPF (29 cases, 45.3%); only 10 (15.6%) cases were grade B/C (8 cases were Grade B and 2 cases were Grade C treated with digital subtraction angiography). Bile leakage occurred in 2 (3.1%) patients. One (1.5%) patient had a gastric fistula, and 3 (4.7%) developed postoperative delayed gastric emptying categorized as International Study Group of Pancreatic Surgery (ISGPS) Grade A. Three (4.7%) patients were readmitted for postoperative bleeding, and 2 (3.1%) died within 30 days.
Hybrid PD with laparoscopic and robot surgery is safe and feasible. OT can be reduced by switching from the laparoscopic approach to the robotic procedure at the appropriate timepoint.
微创手术对胰腺手术有益，适应证已扩大到胰十二指肠切除术（PD）。本研究旨在分享我们在腹腔镜和机器人手术中进行杂交 PD 的经验。
2016 年 7 月至 2019 年 6 月，同一机构的同一位外科医生进行了 64 例杂交 PD，标本切除和胃肠吻合术通过腹腔镜途径进行，胰肠吻合术和胆肠吻合术通过机器人途径进行。主要终点是并发症；次要终点是手术时间（OT）、住院时间和出血量。患者的数据从电子病历中回顾性获得。
所有患者均成功完成了杂交手术。OT 和估计出血量（EBL）的平均时间分别为 309.7±77.6 分钟（范围 17-620 分钟）和 160±31.7 毫升（范围 50-800 毫升）。平均淋巴结检出数为 7.3±6.7（范围 0-37），45 例恶性病例为 8.42±6.7（范围 1-37）。平均术后住院时间为 11.14±7.03 天（范围 6-47 天）。39 例（60.9%）发生临床相关的术后胰瘘（POPF），其中大多数为生化漏 POPF（29 例，45.3%）；仅 10 例（15.6%）为 B/C 级（8 例为 B 级，2 例为 C 级，经数字减影血管造影治疗）。2 例（3.1%）患者发生胆漏。1 例（1.5%）患者发生胃瘘，3 例（4.7%）发生国际胰腺外科研究组（ISGPS）分级 A 的术后胃排空延迟。3 例（4.7%）患者因术后出血再次入院，2 例（3.1%）患者在 30 天内死亡。
腹腔镜和机器人手术的杂交 PD 是安全可行的。通过在适当的时间点从腹腔镜转为机器人手术，OT 可以减少。
