Takeda Yutaka, Ohmura Yoshiaki, Katsura Yoshiteru, Shinke Go, Kinoshita Mitsuru, Aoyama Shu, Kihara Yukari, Yanagisawa Kiminori, Katsuyama Shinsuke, Ikeshima Ryo, Hiraki Masayuki, Sugimura Keijiro, Masuzawa Toru, Hata Taishi, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1506-1508.
Laparoscopic pancreaticoduodenectomy(LPD)has been covered by insurance since 2016 in Japan. Advance LPD and robotic pancreaticoduodenectomy(RPD)has been also covered by insurance since 2020 in Japan. We report our technique and the short-term outcome of RPD performed in our institution.
As a first step, the resection phase was performed laparoscopically. Pancreato-jejunostomy and choledocho-jejunostomy were performed robotically (hybrid-RPD). As a second step, Kocher maneuver and jejunal transection were performed laparoscopically. Other procedures were performed robotically(modified-RPD). As a final step, all procedures were performed robotically(pure-RPD).
RPD is performed in reverse Trendelenburg supine position. An extended Kocher maneuver is performed. The common bile duct is then identified and transected after proximal aspect is secured with a surgical bulldog clamp. IPDA is divided by using an energy device after clip placement. The pancreatic neck is then divided with the use of scissors. Pancreato-jejunostomy was performed by modified Blumgart and pancreatic duct to jejunal mucosa method. Choledocho- jejunostomy was performed with continuous and interrupted suturing.
Between 2020 and 2022, 45 patients underwent RPD at our institution. Cases were divided into hybrid-RPD(n=20), modified-RPD(n=9) and pure-RPD(n=16).
No significant differences were noted between hybrid-RPD, modified-RPD and pure-RPD groups with respect to patient age(73.6, 68.7, 70.6 years old), gender(male/female 15/5, 6/3, 8/8), respectively. The operation time was longer(667, 770, 746 minutes)and the resection time was longer(286, 399, 380 minutes)in modified- RPD and pure-RPD than hybrid-RPD group. In the pure-RPD group, the resection time was decreasing(y=-12.0×+ 481.5)as a learning curve. No significant differences were noted between hybrid-RPD, modified-RPD and pure-RPD groups with respect to reconstruction time(388, 371, 367 minutes)and the estimated blood(261, 199, 293 mL), respectively. All postoperative pancreatic fistula was under Grade B.
Although further studies are still needed to confirm the benefit of RPD, RPD is safe, minimally invasive, and effective approach to the management of pancreatic tumor.
自2016年起，腹腔镜胰十二指肠切除术（LPD）在日本已纳入医保范围。自2020年起，进阶版LPD和机器人胰十二指肠切除术（RPD）在日本也已纳入医保范围。我们报告了在本机构实施的RPD技术及短期结果。
第一步，采用腹腔镜进行切除阶段。胰空肠吻合术和胆总管空肠吻合术通过机器人操作完成（杂交RPD）。第二步，通过腹腔镜进行 Kocher 手法和空肠横断术。其他步骤通过机器人操作完成（改良RPD）。最后一步，所有操作均通过机器人完成（纯RPD）。
RPD采用反向头低脚高位仰卧位进行。进行扩大的 Kocher 手法。然后识别胆总管，在近端用手术夹钳固定后切断。放置夹子后使用能量装置切断胰十二指肠下动脉（IPDA）。然后用剪刀切断胰腺颈部。胰空肠吻合术采用改良的 Blumgart 法和胰管对空肠黏膜法进行。胆总管空肠吻合术采用连续和间断缝合。
2020年至2022年期间，本机构有45例患者接受了RPD手术。病例分为杂交RPD组（n = 20）、改良RPD组（n = 9）和纯RPD组（n = 16）。
杂交RPD组、改良RPD组和纯RPD组在患者年龄（分别为73.6岁、68.7岁、70.6岁）、性别（男/女分别为15/5、6/3、8/8）方面无显著差异。改良RPD组和纯RPD组的手术时间（分别为667、770、746分钟）和切除时间（分别为286、399、380分钟）比杂交RPD组长。在纯RPD组中，作为学习曲线，切除时间呈下降趋势（y = -12.0x + 481.5）。杂交RPD组、改良RPD组和纯RPD组在重建时间（分别为388、371、367分钟）和估计出血量（分别为261、199、293 mL）方面无显著差异。所有术后胰瘘均为B级以下。
尽管仍需进一步研究以证实RPD的益处，但RPD是一种安全、微创且有效的胰腺肿瘤治疗方法。
