Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Surg Laparosc Endosc Percutan Tech. 2024 Oct 1;34(5):472-478. doi: 10.1097/SLE.0000000000001289.
Minimally invasive spleen-preserving distal pancreatectomy with Warshaw procedure (MI-WP), has gained widespread recognition for the treatment of benign and low-grade malignant tumors of the pancreatic body and tail. However, the comparative advantages of the robotic Warshaw procedure (R-WP) over the laparoscopic Warshaw procedure (L-WP) remain uncertain. This study aimed to compare the surgical outcomes between R-WP and L-WP.
Among the 146 cases of MI-DP conducted between October 2020 and December 2023 (L-DP:115, R-DP:31), 33 cases of MI-WP were subjected to analysis, comprising the R-WP group (n=10) and the L-WP group (n=23).
R-WP successfully completed all procedures under a purely laparoscopic approach, whereas L-WP necessitated conversion to open surgery in 2 cases (8.7%). Despite the significantly prolonged operative time in R-WP compared with L-WP (R-WP vs. L-WP: 421vs. 300 min), there was no significant difference in estimated blood loss between the 2 groups (R-WP vs. L-WP: 19 vs. 20 mL). Although the rate of major complications did not significantly differ between the 2 groups, 2 cases (8.7%) of L-WP required reoperation, including splenectomy in 1 instance. Furthermore, the incidence of postoperative splenic infarction was significantly higher in L-WP than in R-WP (R- vs. L-WP:0 vs. 43.5%, P =0.015). The length of hospital stay after surgery did not exhibit a significant difference between the 2 groups (R-WP vs. L-WP: 11 vs. 12 d).
R-WP demonstrated superiority to L-WP for reducing the incidence of postoperative splenic infarction, potentially contributing to enhancing the spleen preservation rate.
保留脾脏的胰体尾切除术联合 Warshaw 术（MI-WP）已广泛应用于胰腺体尾部良性及低级别恶性肿瘤的治疗。然而，机器人 Warshaw 术（R-WP）相较于腹腔镜 Warshaw 术（L-WP）的比较优势尚不确定。本研究旨在比较 R-WP 和 L-WP 的手术结果。
2020 年 10 月至 2023 年 12 月间，我们共开展了 146 例 MI-DP（L-DP：115 例，R-DP：31 例），其中 33 例行 MI-WP 分析，包括 R-WP 组（n=10）和 L-WP 组（n=23）。
R-WP 全部成功完成了纯腹腔镜下的手术，而 L-WP 中有 2 例（8.7%）需要中转开腹。虽然 R-WP 的手术时间明显长于 L-WP（R-WP 组 vs. L-WP 组：421 vs. 300 min），但两组间的估计出血量无明显差异（R-WP 组 vs. L-WP 组：19 vs. 20 ml）。虽然两组的主要并发症发生率无显著差异，但 L-WP 组有 2 例（8.7%）需要再次手术，其中 1 例为脾切除术。此外，L-WP 的术后脾梗死发生率明显高于 R-WP（R-WP 组 vs. L-WP 组：0 vs. 43.5%，P=0.015）。两组间术后住院时间无显著差异（R-WP 组 vs. L-WP 组：11 vs. 12 d）。
R-WP 较 L-WP 可降低术后脾梗死的发生率，有助于提高脾脏保留率。
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