Lefor Alan Kawarai
Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi Japan.
BMC Biomed Eng. 2019 Jan 30;1:2. doi: 10.1186/s42490-019-0001-4. eCollection 2019.
Surgery of the pancreas is a relatively new field, with operative series appearing only in the last 50 years. Surgery of the pancreas is technically challenging. The entire field of general surgery changed radically in 1987 with the introduction of the laparoscopic cholecystectomy. Minimally Invasive surgical techniques rapidly became utilized worldwide for gallbladder surgery and were then adapted to other abdominal operations. These techniques are used regularly for surgery of the pancreas including distal pancreatectomy and pancreatoduodenectomy. The progression from open surgery to laparoscopy to robotic surgery has occurred for many operations including adrenalectomy, thyroidectomy, colon resection, prostatectomy, gastrectomy and others. Data to show a benefit to the patient are scarce for robotic surgery, although both laparoscopic and robotic surgery of the pancreas have been shown not to be inferior with regard to major operative and oncologic outcomes. While there were serious concerns when laparoscopy was first used in patients with malignancies, robotic surgery has been used in many benign and malignant conditions with no obvious deterioration of outcomes. Robotic surgery for malignancies of the pancreas is well accepted and expanding to more centers. The importance of centers of excellence, surgeon experience supported by a codified mastery-based training program and international registries is widely accepted. Robotic pancreatic surgery is associated with slightly decreased blood loss and decreased length of stay compared to open surgery. Major oncologic outcomes appear to have been preserved, with some studies showing higher rates of R0 resection and tumor-free margins. Patients with lesions of the pancreas should find a surgeon they trust and do not need to be concerned with the operative approach used for their resection. The step-wise approach that has characterized the growth in robotic surgery of the pancreas, in contradistinction to the frenzy that accompanied the introduction of laparoscopic cholecystectomy, has allowed the identification of areas for improvement, many of which lie at the junction of engineering and medical practice. Refinements in robotic surgery depend on a partnership between engineers and clinicians.
胰腺手术是一个相对较新的领域，手术系列报道直到最近50年才出现。胰腺手术在技术上具有挑战性。1987年腹腔镜胆囊切除术的引入使普通外科的整个领域发生了根本性变化。微创外科技术迅速在全球范围内被用于胆囊手术，随后又被应用于其他腹部手术。这些技术经常用于胰腺手术，包括胰腺远端切除术和胰十二指肠切除术。包括肾上腺切除术、甲状腺切除术、结肠切除术、前列腺切除术、胃切除术等在内的许多手术都经历了从开放手术到腹腔镜手术再到机器人手术的发展过程。虽然机器人手术对患者有益的数据很少，但胰腺的腹腔镜手术和机器人手术在主要手术和肿瘤学结果方面均未显示出劣势。虽然腹腔镜手术最初用于恶性肿瘤患者时曾引发严重担忧，但机器人手术已被用于许多良性和恶性疾病，且结果并无明显恶化。胰腺恶性肿瘤的机器人手术已被广泛接受，并正在扩展到更多中心。卓越中心、基于规范化掌握培训计划支持的外科医生经验以及国际注册登记的重要性已得到广泛认可。与开放手术相比，机器人胰腺手术的失血量略有减少，住院时间缩短。主要肿瘤学结果似乎得以保留，一些研究显示R0切除率和切缘无瘤率更高。胰腺病变患者应找到他们信任的外科医生，无需担心其切除手术所采用的手术方式。与腹腔镜胆囊切除术引入时的狂热不同，胰腺机器人手术的发展呈现出循序渐进的方式，这使得能够确定改进领域，其中许多领域位于工程与医疗实践的交叉点。机器人手术的改进依赖于工程师与临床医生之间的合作。
