Fong Zhi Ven, Zwart Maurice J W, Gorris Myrte, Voermans Rogier P, van Wanrooij Roy L J, Wielenga Thijs, Del Chiaro Marco, Arnelo Urban, Daams Freek, Busch Olivier R, Besselink Marc G
From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
Dana Farber Cancer Institute, Mass General Brigham, Harvard Medical School, Boston, MA.
Ann Surg Open. 2023 May 5;4(2):e283. doi: 10.1097/AS9.0000000000000283. eCollection 2023 Jun.
Intraductal papillary mucinous neoplasm (IPMN) with involvement of the main pancreatic duct usually requires surgical resection. Consensus is lacking whether to partially or completely resect the pancreatic portion with a dilated main pancreatic duct. Intraoperative pancreatoscopy may be useful to determine the extent of IPMN to tailor surgical resection and was recently studied in a large prospective international study. IPMN is increasingly utilized using a robotic approach. Studies describing the technical approach to intraoperative pancreatoscopy in robotic pancreatoduodenectomy and robotic distal pancreatectomy are lacking.
During robotic pancreatoduodenectomy, pancreatoscopy is performed once the pancreas neck is transected. The scope is advanced via a laparoscopic port into the left and right-sided pancreatic duct, guided by robotic graspers. During robotic distal pancreatectomy, pancreatoscopy is performed before complete parenchymal transection. The scope is advanced through an anterior ductotomy to examine the duct and guide the pancreatic transection line. Tips and tricks how to perform the procedure efficiently without complications are detailed.
In total, 28 robot-assisted pancreatoscopies were performed during robotic pancreatoduodenectomy and robotic distal pancreatectomy. No intraoperative complications resulting from the intraoperative pancreatoscopy were noted. In the 2 described procedures, the added time required to perform the pancreatoscopy was 6 and 17 minutes, respectively. Both patients recovered without complication and were discharged on postoperative day 5 for the robotic pancreatoduodenectomy and day 6 for the robotic distal pancreatectomy.
Intraoperative pancreatoscopy can be safely performed during both robotic pancreatoduodenectomy and robotic distal pancreatectomy for IPMN with the involvement of the main pancreatic duct. An international prospective study has recently been completed with this technique.
累及主胰管的导管内乳头状黏液性肿瘤（IPMN）通常需要手术切除。对于是否部分或完全切除伴有主胰管扩张的胰腺部分，目前尚无共识。术中胰管镜检查可能有助于确定IPMN的范围以指导手术切除，最近一项大型国际前瞻性研究对其进行了探讨。IPMN越来越多地采用机器人手术方法。目前缺乏关于机器人胰十二指肠切除术和机器人远端胰腺切除术中术中胰管镜检查技术方法的描述。
在机器人胰十二指肠切除术中，胰腺颈部横断后进行胰管镜检查。在机器人抓钳引导下，通过腹腔镜端口将内镜推进至左右主胰管。在机器人远端胰腺切除术中，在实质完全横断前进行胰管镜检查。通过前部导管切开术将内镜推进以检查导管并指导胰腺横断线。详细介绍了如何高效进行该操作且无并发症的技巧和窍门。
在机器人胰十二指肠切除术和机器人远端胰腺切除术中，共进行了28次机器人辅助胰管镜检查。未发现术中胰管镜检查引起的术中并发症。在上述两种手术中，进行胰管镜检查所需的额外时间分别为6分钟和17分钟。两名患者均顺利康复，机器人胰十二指肠切除术患者术后第5天出院，机器人远端胰腺切除术患者术后第6天出院。
对于累及主胰管的IPMN，在机器人胰十二指肠切除术和机器人远端胰腺切除术中均可安全地进行术中胰管镜检查。最近已完成一项关于该技术的国际前瞻性研究。
