Spleen-preservation has recently been emphasized in benign and borderline malignant pancreatic diseases requiring distal pancreatectomy. Reports to suggest that laparoscopic distal pancreatectomy is feasible and safe have been increasingly published. Robotic surgical system has been introduced and is expected to provide unique advantages in laparoscopic surgery. However, robot-assisted pancreatic surgery has not yet been performed by many surgeons. A 45-year-old female patient with abdominal discomfort was found to have pancreatic cyst in the body of the pancreas. Mucinous cystic tumor of the pancreas was the most favourable preoperative diagnosis. She underwent spleen-preserving laparoscopic distal pancreatectomy by using da Vinci surgical robot system. Splenic artery and vein were so tightly adherent to the pancreatic cyst that segmental resection of splenic vessels was required. Postoperative course was uneventful. She was able to come home in 5 days after surgery. Postoperative follow up color doppler ultrasound scan, taken on 2 weeks after surgery, showed minimal fluid collection around surgical field and no evidence of splenic infarction with good preservation of splenic perfusion. Robot-assisted spleen preserving distal pancreatectomy is thought to be feasible and safe. Several unique advantages of robotic system are expected to enhance safer and more precise surgical performance in near future. More experiences are mandatory to confirm real benefit of robot surgery in pancreatic disease.
Female ; Humans ; Laparoscopy/instrumentation/*methods ; Middle Aged ; Pancreatectomy/instrumentation/*methods ; Pancreatic Cyst/*surgery ; *Robotics ; Spleen/pathology/*surgery

Objective: To evaluate the feasibility and safety of applying enhanced recovery after surgery (ERAS) protocol in patients undergoing laparoscopic distal pancreatectomy. Methods: Data of 36 patients undergoing laparoscopic distal pancreatectomy from May 2016 to May 2017 in the First Affiliated Hospital, Zhejiang University School of Medicine were reviewed. The patients were divided into ERAS group (n=12) and control group (n=24). The patients in ERAS group received a series of enhanced recovery procedures, including multimodal analgesia, early off-bed activity and early oral food-taking, etc. Operation time, intraoperative blood loss, time to first flatus, postoperative complications, and length of postoperative hospital stay were evaluated. Results: There were no statistically significant differences in operation time and intraoperative blood loss between ERAS group and control group (all P0.05). The time to first flatus and length of postoperative hospital stay were significantly shortened in ERAS group (all P<0.05). The ERAS group had lower incidence of postoperative complications (41.7% vs. 66.7%), and the complications in ERAS group tended to be milder, but the differences failed to show statistical significance (all P0.05). Conclusion: The ERAS protocol for laparoscopic distal pancreatectomy can significantly promote gastrointestinal function recovery and shorten postoperative hospital stay, and may reduce the incidence of postoperative complications.
Case-Control Studies ; Humans ; Laparoscopy ; standards ; Length of Stay ; Pancreatectomy ; instrumentation ; methods ; Postoperative Complications ; prevention & control ; Postoperative Period ; Retrospective Studies

OBJECTIVETo determine the influence of hand-sewn and stapler in distal pancreatectomy on the postoperative complication.

METHODSClinical data of 109 patients after distal pancreatectomy from January 2003 to December 2006 were analyzed retrospectively.

RESULTSThe surgical techniques used for closure of the pancreatic stump after distal pancreatectomy were categorized into hand-sewn closure group (n = 53) and stapler closure group (n = 56). In stapler closure group, 25 patients accepted laparoscopic operation. The incidences of abdominal infection and pancreatic fistulae in stapler closure group were lower than hand-sewn closure group. The operation time, blood infusion, postoperative bleeding and medical costs were similar between two groups.

CONCLUSIONStapler closure in distal pancreatectomy could decrease the incidence of pancreatic fistula and abdominal infections.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; instrumentation ; methods ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreatic Neoplasms ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Surgical Staplers ; Surgical Wound Infection ; prevention & control ; Young Adult