Pancreatic Anastomosis in Robotic-Assisted Pancreaticoduodenectomy: Different Surgical Techniques.

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2023-01-01 DOI:10.1159/000528646
Matteo De Pastena, Elisa Bannone, Elena Andreotti, Chiara Filippini, Marco Ramera, Alessandro Esposito, Roberto Salvia
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Abstract

Robot-assisted pancreatoduodenectomy (R-PD) may provide challenges but potential benefits for pancreatic-enteric anastomosis fashioning. Despite numerous trials comparing different pancreatic-enteric anastomosis techniques, an ideal method is still missing. This study aims to describe different management strategies and surgical techniques of standardized pancreatic-enteric anastomoses during an R-PD. This study reported the robotic technical steps of the modified end-to-side Blumgart pancreaticojejunostomy, the Cattel-Warren duct-to-mucosa pancreatojejunostomy, with internal or external pancreatic duct stent, and the modified end-to-side, double-layer pancreogastrostomy. A dual-console da Vinci Xi Surgical System® (Intuitive Surgical Xi, Sunnyvale, CA) was used to perform all the R-PD. Different robotic pancreatic-enteric anastomosis techniques can be used during the reconstruction phase, possibly reproducing the open technique. The type of anastomosis and applied mitigation strategies should balance surgical strategy adaptability and operative technique standardization. R-PD should be performed in high-volume centers by surgeons with extensive experience in pancreatic and advanced MI surgery, enabling different but standardized anastomotic techniques based on patients' risk factors and intraoperative findings. Future studies on robotic pancreatic anastomosis should focus on personalized approaches after adequate risk stratification.

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机器人辅助胰十二指肠切除术中的胰腺吻合:不同的手术技术。
机器人辅助胰十二指肠切除术(R-PD)可能会给胰肠吻合形成带来挑战,但也有潜在的好处。尽管许多试验比较了不同的胰肠吻合技术,但仍缺乏理想的方法。本研究旨在描述在R-PD期间标准化胰肠吻合术的不同管理策略和手术技术。本研究报道了改良的端侧Blumgart胰空肠吻合术、Cattel-Warren胰空肠导管到粘膜胰空肠吻合术(胰管内支架或胰管外支架)和改良的端侧双层胰胃吻合术的机器人技术步骤。在重建阶段可以使用不同的机器人胰肠吻合技术,可能复制开放技术。吻合方式和采用的缓解策略应兼顾手术策略的适应性和手术技术的规范化。R-PD应在大容量中心由具有丰富胰腺和晚期心肌梗死手术经验的外科医生进行,根据患者的危险因素和术中发现,采用不同但标准化的吻合技术。未来对机器人胰腺吻合术的研究应侧重于在充分的风险分层后的个性化方法。
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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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