Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Surg Endosc. 2024 Oct;38(10):6169-6176. doi: 10.1007/s00464-024-11219-6. Epub 2024 Sep 3.
Since robotic pancreaticoduodenectomy (R-PD) has emerged as a promising technique for treating periampullary tumors, optimal surgical views across various stages of the surgery are vital. This study aimed to describe the evolution and optimization of the multiple scope transition (MST) method using comprehensive videos and illustrations, particularly from the perspective of the patient-side assistants, to enhance the efficiency and safety of R-PD through its different phases.
We retrospectively analyzed 61 patients who underwent R-PD from April 2021 to May 2023.
The median total operation duration was 599 min (415-840 min). The median scope transition times for redocking from the left to central lower position, transition from the central lower to upper position, and port-hopping from the central to right position were 169 s (53-725 s), 55 s (26-165 s), and 120 s (41-260 s), respectively. Owing to the advancements in the scope transition procedures, these scope transition times became shorter with an increase in the number of experiences. No intraoperative complications relevant to scope transition was reported, and the incidence of significant postoperative complications greater than Grade IIIa of the Clavien-Dindo classification was 8.2%.
We reported the established role and evolution of the MST method from the standpoint of the patient-side assistants. The comfortable surgical field expansion provided by the MST method can ensure the safe and widespread application of R-PD.
由于机器人胰十二指肠切除术（R-PD）已成为治疗壶腹周围肿瘤的有前途的技术，因此在手术的各个阶段获得最佳手术视野至关重要。本研究旨在通过综合视频和插图描述多镜过渡（MST）方法的演变和优化，特别是从患者侧助手的角度，通过不同阶段提高 R-PD 的效率和安全性。
我们回顾性分析了 2021 年 4 月至 2023 年 5 月期间接受 R-PD 的 61 名患者。
中位总手术时间为 599 分钟（415-840 分钟）。从左侧到中央下位置、从中部下位置到上位置和从中央到右侧位置的重新对接的中位镜过渡时间分别为 169 秒（53-725 秒）、55 秒（26-165 秒）和 120 秒（41-260 秒）。由于镜过渡程序的进步，这些镜过渡时间随着经验的增加而缩短。没有与镜过渡相关的术中并发症报告，且术后并发症发生率大于 Clavien-Dindo 分级 IIIa 级别的为 8.2%。
我们从患者侧助手的角度报告了 MST 方法的既定作用和演变。MST 方法提供的舒适手术视野扩展可以确保 R-PD 的安全广泛应用。
