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A comparative study on the complications of conventional and end-to-side inserting pancreatojejunostomy after pancreaticoduodenectomy. Surg Today 2016; 47:238-244. [DOI: 10.1007/s00595-016-1364-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/15/2016] [Indexed: 12/19/2022]
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Baker EH, Ross SW, Seshadri R, Swan RZ, Iannitti DA, Vrochides D, Martinie JB. Robotic pancreaticoduodenectomy for pancreatic adenocarcinoma: role in 2014 and beyond. J Gastrointest Oncol 2015; 6:396-405. [PMID: 26261726 DOI: 10.3978/j.issn.2078-6891.2015.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/09/2015] [Indexed: 12/26/2022] Open
Abstract
Minimally invasive surgery (MIS) for pancreatic adenocarcinoma has found new avenues for performing pancreaticoduodenectomy (PD) procedures, a historically technically challenging operation. Multiple studies have found laparoscopic PD to be safe, with equivalent oncologic outcomes as compared to open PD. In addition, several series have described potential benefits to minimally invasive PD including fewer postoperative complications, shorter hospital length of stay, and decreased postoperative pain. Yet, despite these promising initial results, laparoscopic PDs have not become widely adopted by the surgical community. In fact, the vast majority of pancreatic resections performed in the United States are still performed in an open fashion, and there are only a handful of surgeons who actually perform purely laparoscopic PDs. On the other hand, robotic assisted surgery offers many technical advantages over laparoscopic surgery including high-definition, 3-D optics, enhanced suturing ability, and more degrees of freedom of movement by means of fully-wristed instruments. Similar to laparoscopic PD, there are now several case series that have demonstrated the feasibility and safety of robotic PD with seemingly equivalent short-term oncologic outcomes as compared to open technique. In addition, having the surgeon seated for the procedure with padded arm-rests, there is an ergonomic advantage of robotics over both open and laparoscopic approaches, where one has to stand up for prolonged periods of time. Future technologic innovations will likely focus on enhanced robotic capabilities to improve ease of use in the operating room. Last but not least, robotic assisted surgery training will continue to be a part of surgical education curriculum ensuring the increased use of this technology by future generations of surgeons.
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Affiliation(s)
- Erin H Baker
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Samuel W Ross
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Ramanathan Seshadri
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Ryan Z Swan
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - David A Iannitti
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Dionisios Vrochides
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - John B Martinie
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
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Lee JS, Hong TH. In vivo porcine training model for laparoscopic Roux-en-Y choledochojejunostomy. Ann Surg Treat Res 2015; 88:306-10. [PMID: 26029675 PMCID: PMC4443261 DOI: 10.4174/astr.2015.88.6.306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/30/2014] [Accepted: 12/15/2014] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated. Methods Laparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180). Results The average operation time was 131.3 ± 36.4 minutes, and the CJ time was 57.5 ± 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 ± 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture. Conclusion The porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.
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Affiliation(s)
- Jun Suh Lee
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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