Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Surg Laparosc Endosc Percutan Tech. 2024 Feb 1;34(1):113-116. doi: 10.1097/SLE.0000000000001246.
Minimally invasive distal pancreatectomy has become a widely accepted procedure for tumors located in the pancreatic body or tail. However, pancreatic transection by linear stapler is generally avoided for pancreatic body tumors located above the portal vein because the surgical margin width is narrowed after taking into account the cutting allowance for insertion of the stapling device. Herein, we report a parenchymal clamp-crushing procedure that provides a sufficient surgical margin in pancreatic transection.
Two patients with suspected early pancreatic cancer underwent pancreatic transection using the clamp-crushing procedure. The planned pancreatic transection line was set just to the left of the gastroduodenal artery in both cases. Robotic and laparoscopic distal pancreatectomy were performed in 1 patient each. Patients were positioned supine with split legs. Parenchymal transection was performed with crushing by VIO 3 (ERBE Elektromedizin) operated in softCOAG Bipolar mode with Effect 2/modulation 50. After crushing, remnant tissue was cut in autoCUT Bipolar mode operated by VIO 3 with Effect 2/modulation 50, or cut after secured by clipping.
The surgical duration was 253 and 212 minutes, and estimated blood loss was 0 and 50 mL in the 2 patients, and both were discharged with uneventful courses. Pathologic examination confirmed a negative surgical margin in both patients.
Clamp-crushing pancreatic transection for distal pancreatectomy might be a suitable treatment option for achieving sufficient surgical margin in pancreatic body tumors located close to the portal vein.
对于位于胰体或胰尾的肿瘤，微创远端胰腺切除术已成为一种广泛接受的手术方法。然而，对于位于门静脉上方的胰体肿瘤，一般避免使用线性吻合器进行胰腺横断，因为考虑到吻合器插入的切割余量后，手术切缘宽度会变窄。在此，我们报告一种用于胰腺横断的实质夹压榨程序，该程序可提供足够的手术切缘。
两名疑似早期胰腺癌患者接受了夹压榨程序的胰腺横断。在这两种情况下，计划的胰腺横断线都设置在胃十二指肠动脉的左侧。1 例患者接受了机器人辅助腹腔镜远端胰腺切除术，另 1 例患者接受了腹腔镜远端胰腺切除术。患者仰卧位，双腿分开。使用 VIO 3（ERBE Elektromedizin）在软 COAG 双极模式下以 Effect 2/modulation 50 进行操作进行实质横断，通过 Crush 进行粉碎。粉碎后，使用 VIO 3 的自动切割双极模式以 Effect 2/modulation 50 进行切割残余组织，或用夹夹固定后进行切割。
2 名患者的手术时间分别为 253 分钟和 212 分钟，估计出血量分别为 0 毫升和 50 毫升，均顺利出院。病理检查证实 2 名患者的手术切缘均为阴性。
对于靠近门静脉的胰体肿瘤，夹压榨胰腺横断术可能是一种实现足够手术切缘的合适治疗选择。
