Application value of robot-assisted parenchyma-sparing pancreatectomy
10.3760/cma.j.cn115610-20240321-00174
- VernacularTitle:机器人辅助保留胰腺实质切除术的应用价值
- Author:
Xianchao LIN
1
;
Ronggui LIN
;
Fengchun LU
;
Yuanyuan YANG
;
Congfei WANG
;
Heguang HUANG
Author Information
1. 福建医科大学附属协和医院基本外科，福州 350001
- Keywords:
Pancreatic neoplasms;
Robotic pancreatic surgery;
Main pancreatic duct repair;
End-to-end pancreatic anastomosis;
Parenchyma-sparing pancreatectomy
- From:
Chinese Journal of Digestive Surgery
2024;23(5):733-738
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application value of robot-assisted parenchyma-sparing pancreatectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 54 patients who underwent robot-assisted parenchyma-sparing pancrea-tectomy in the Fujian Medical University Union Hospital from January 2017 to February 2023 were collected. There were 22 males and 32 females, aged (44±16)years. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the rank sum test. Count data were expressed as absolute numbers, and comparison between groups was performed using the Fisher exact probability. Results:(1) Intraoperative conditions. All 54 patients underwent robot-assisted parenchyma-sparing pancrea-tectomy successfully, without conversion to laparotomy. Of 54 patients, 32 cases underwent pancreatic tumor enucleation and 22 cases underwent central pancreatectomy. Of the 32 patients who underwent pancreatic tumor enucleation, 29 cases underwent conventional pancreatic tumor enucleation, and 3 cases underwent intraoperative repairing of main pancreatic duct injury. Of the 22 patients who underwent central pancreatectomy, 15 cases underwent end-to-end anastomosis, and 7 cases underwent Roux-en-Y pancreaticojejunostomy. There was no significant difference in operation time or volume of intraoperative blood loss between 29 patients undergoing conventional pancreatic tumor enucleation and 3 patients undergoing intraoperative repairing of main pancreatic duct injury ( t=-1.66, Z=-0.82, P>0.05). There were significant differences in operation time and volume of intraoperative blood loss between 15 patients undergoing end-to-end pancreatic anastomosis and 7 patients undergoing Roux-en-Y pancreaticojejunostomy ( t=-3.03, Z=-2.22, P<0.05). (2) Postoperative conditions. There were 38 of the 54 patients with postoperative complications, including 37 cases of pancreatic fistula and 1 case of delayed gastric emptying. There was no significant difference in post-operative pancreatic fistula between 29 patients undergoing conventional pancreatic tumor enuclea-tion and 3 patients undergoing intraoperative repairing of main pancreatic duct injury ( P>0.05). There was a significant difference in postoperative pancreatic fistula between 15 patients under-going end-to-end pancreatic anastomosis and 7 patients undergoing Roux-en-Y pancreaticojejunostomy ( P<0.05). (3) Follow-up. All 54 patients were followed up for 23(range, 3-76)months, and all of them survived without tumor recurrence or metastasis. None of the 32 patients undergoing enuclea-tion of pancreatic tumor experienced pancreatic endocrine or exocrine insufficiency. Of the 15 patients who underwent end-to-end pancreatic anastomosis, there were 2 cases of dilatation of the main pancreatic duct and atrophy of the distal pancreas, 1 case of pancreatic endocrine insufficiency and 1 case of exocrine insufficiency. Of the 7 patients who underwent Roux-en-Y pancreaticojejunostomy, there was 1 case of pancreatic endocrine insufficiency. Conclusion:Robot-assisted parenchyma-sparing pancreatectomy can provide intraoperative protection, repair and anastomosis of the main pancreatic duct.
