Nove de Julho Hospital, São Paulo, Brazil.
Ann Surg Oncol. 2021 Oct;28(11):6257-6261. doi: 10.1245/s10434-021-09776-4. Epub 2021 Mar 6.
Surgical resection with adjuvant or neoadjuvant chemotherapy is the only curative modality for treatment of patients with pancreatic and periampullary tumors. With the increasing use of minimally invasive techniques, laparoscopic and robotic pancreatoduodenectomy (PD) has become more common, but laparoscopic artery-first techniques have been described in few studies. The aim of this study is to describe our robotic artery-first technique.
Video clips were compiled from several robotic PDs to demonstrate the artery-first technique. This technique consists of early retroperitoneal dissection of the superior mesenteric artery from the pancreatic head.
Overall, 73 patients underwent robotic PD at our center between March 2018 and August 2020. Of these, 24 patients underwent the robotic artery-first approach. Indication for its use included proximity of the tumor to the portal vein or SMV in six cases. In three cases, partial resection of the portomesenteric axis was necessary, and the artery-first approach allowed for safe venous resection and reconstruction. In three other cases, the tumor was in close contact with the vein, but it could be resected with free margins without venous resection. In the remaining 18 patients, the approach was systematically used regardless of tumor proximity to the portomesenteric axis.
This robotic artery-first approach is feasible and safe for PD. The approach could facilitate robotic PD, and its systematical use could provide some important advantages during the resection phase. The videos could also help oncological surgeons to perform this complex yet important maneuver.
对于胰腺和壶腹周围肿瘤患者，手术切除联合辅助或新辅助化疗是唯一的治愈方式。随着微创技术的应用日益增多，腹腔镜和机器人胰十二指肠切除术（PD）已变得更为常见，但采用腹腔镜动脉优先技术的研究较少。本研究旨在介绍我们的机器人动脉优先技术。
从几例机器人 PD 中整理出视频剪辑以展示动脉优先技术。该技术包括从胰腺头部的肠系膜上动脉进行早期腹膜后解剖。
2018 年 3 月至 2020 年 8 月，我们中心共有 73 例患者接受了机器人 PD，其中 24 例患者采用了机器人动脉优先方法。有 6 例患者因肿瘤靠近门静脉或 SMV 而采用该方法；3 例患者需要进行部分门肠系膜轴切除术，动脉优先方法可安全地进行静脉切除和重建；另外 3 例患者的肿瘤与静脉紧密接触，但可以在不切除静脉的情况下进行无肿瘤边界的切除；在其余 18 例患者中，无论肿瘤与门肠系膜轴的距离如何，均系统地采用该方法。
该机器人动脉优先方法适用于 PD，且安全可行。该方法可促进机器人 PD 的实施，其系统应用在切除阶段可提供一些重要优势。这些视频还可以帮助肿瘤外科医生进行这一复杂但重要的操作。
