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Wu X, Wang D, Xiang N, Pan M, Jia F, Yang J, Fang C. Augmented reality-assisted navigation system contributes to better intraoperative and short-time outcomes of laparoscopic pancreaticoduodenectomy: a retrospective cohort study. Int J Surg 2023; 109:2598-2607. [PMID: 37338535 PMCID: PMC10498855 DOI: 10.1097/js9.0000000000000536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Augmented reality (AR)-assisted navigation system are currently good techniques for hepatectomy; however, its application and efficacy for laparoscopic pancreatoduodenectomy have not been reported. This study sought to focus on and evaluate the advantages of laparoscopic pancreatoduodenectomy guided by the AR-assisted navigation system in intraoperative and short-time outcomes. METHODS Eighty-two patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to May 2022 were enrolled and divided into the AR and non-AR groups. Clinical baseline features, operation time, intraoperative blood loss, blood transfusion rate, perioperative complications, and mortality were analyzed. RESULTS AR-guided laparoscopic pancreaticoduodenectomy was performed in the AR group ( n =41), whereas laparoscopic pancreatoduodenectomy was carried out routinely in the non-AR group ( n =41). There was no significant difference in baseline data between the two groups ( P >0.05); Although the operation time of the AR group was longer than that of the non-AR group (420.15±94.38 vs. 348.98±76.15, P <0.001), the AR group had a less intraoperative blood loss (219.51±167.03 vs. 312.20±195.51, P =0.023), lower blood transfusion rate (24.4 vs. 65.9%, P <0.001), lower occurrence rates of postoperative pancreatic fistula (12.2 vs. 46.3%, P =0.002) and bile leakage (0 vs. 14.6%, P =0.026), and shorter postoperative hospital stay (11.29±2.78 vs. 20.04±11.22, P <0.001) compared with the non-AR group. CONCLUSION AR-guided laparoscopic pancreatoduodenectomy has significant advantages in identifying important vascular structures, minimizing intraoperative damage, and reducing postoperative complications, suggesting that it is a safe, feasible method with a bright future in the clinical setting.
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Affiliation(s)
- Xiwen Wu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University
- Guangdong Digital Medical Clinical Engineering and Technology Research Center
- Pazhou Lab, Guangzhou
| | - Dehui Wang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University
- Guangdong Digital Medical Clinical Engineering and Technology Research Center
- Pazhou Lab, Guangzhou
| | - Nan Xiang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University
- Guangdong Digital Medical Clinical Engineering and Technology Research Center
- Pazhou Lab, Guangzhou
| | - Mingxin Pan
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University
- Guangdong Digital Medical Clinical Engineering and Technology Research Center
- Pazhou Lab, Guangzhou
| | - Fucang Jia
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University
- Guangdong Digital Medical Clinical Engineering and Technology Research Center
- Pazhou Lab, Guangzhou
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University
- Guangdong Digital Medical Clinical Engineering and Technology Research Center
- Pazhou Lab, Guangzhou
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Gosse J, Cherif R, Brustia R. Robotic-assisted pancreatojejunostomy (with video). J Visc Surg 2023:S1878-7886(23)00033-4. [PMID: 36841640 DOI: 10.1016/j.jviscsurg.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- J Gosse
- Department of digestive and hepato-pancreatic-biliary surgery, DMU CARE, Assistance publique-Hôpitaux de Paris (AP-HP), hôpitaux universitaires Henri-Mondor, 94010 Créteil, France
| | - R Cherif
- Department of digestive and hepato-pancreatic-biliary surgery, DMU CARE, Assistance publique-Hôpitaux de Paris (AP-HP), hôpitaux universitaires Henri-Mondor, 94010 Créteil, France
| | - R Brustia
- Department of digestive and hepato-pancreatic-biliary surgery, DMU CARE, Assistance publique-Hôpitaux de Paris (AP-HP), hôpitaux universitaires Henri-Mondor, 94010 Créteil, France; Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance publique-Hôpitaux de Paris, Créteil, France.
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Shimomura O, Oda T, Miyazaki Y, Furuya K, Doi M, Takahashi K, Kim J, Moue S, Owada Y, Ogawa K, Ohara Y, Akashi Y, Enomoto T, Hashimoto S. Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study. BMC Surg 2022; 22:274. [PMID: 35836157 PMCID: PMC9284870 DOI: 10.1186/s12893-022-01669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pancreatic fistula remains the biggest problem in pancreatic surgery. We have previously reported a new pancreatojejunostomy method using an inter-anastomosis drainage (IAD) suction tube with Blumgart anastomosis for drainage of the pancreatic juice leaking from the branched pancreatic ducts. This study aimed to evaluate the postoperative outcomes of our novel method, in pancreatojejunostomy and investigate the nature of the inter-anastomosis space between jejunal wall and pancreas parenchyma. METHODS This retrospectively study consist of 282 pancreatoduodenectomy cases, including 86 reconstructions via the Blumgart method plus IAD (B + IAD group) and 196 cases reconstructed using the Blumgart method alone (B group). Postoperative outcomes and the amylase value and the volume of the drainage fluids were compared between the two groups. The IAD tube was placed to collect amylase-rich fluid from the inter-anastomosis space during operative procedure between the jejunal wall and pancreatic stump. RESULTS The daily IAD drainage volume and the amylase level was significantly higher in patients with a soft pancreas (vs hard pancreas; 16.5 vs. 10.0 mL/day, p = 0.012; 90,900 vs. 1634 IU/L, p < 0.001, respectively). The mean amylase value of IAD collection in 86 cases of B + IAD group was 63,100 IU/L. The incidence of clinically relevant pancreatic fistula grade B and C (23.2% vs. 23.0%, p = 0.55) and the hospital stay was similar between the groups (median 17 vs. 18 days, p = 0.55). In 176 patients with soft pancreas, the incidence of pancreatic fistula grade B and C (33.3% vs. 35.3%, p = 0.67) and the hospital stay was also similar between the groups (median 22.5 vs. 21 days, p = 0.81). CONCLUSIONS Positive effect of the IAD method observed in the pilot cases was not reproduced in the current study. IAD tube objectively demonstrated the existence of amylase-rich discharge at the anastomosis site, and countermeasures to eliminate this liquid are highly desired for preventing pancreatic fistula, especially in patients with soft pancreatic texture. Trial registration Retrospectively registered.
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Affiliation(s)
- Osamu Shimomura
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tatsuya Oda
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. .,Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yoshihiro Miyazaki
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kinji Furuya
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Manami Doi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuhiro Takahashi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Jaejeong Kim
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shoko Moue
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yohei Owada
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koichi Ogawa
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yusuke Ohara
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshimasa Akashi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tsuyoshi Enomoto
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Hashimoto
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Zhou H, Yu S, Wu X, Li X. Application of purse string suture pancreaticojejunostomy for undilated pancreatic duct in total laparoscopic pancreaticoduodenectomy. BMC Surg 2022; 22:195. [PMID: 35590306 PMCID: PMC9118586 DOI: 10.1186/s12893-022-01640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the feasibility of purse string suture pancreaticojejunostomy in complete laparoscopic pancreaticoduodenectomy for patients with an undilated pancreatic duct. Methods We retrospectively reviewed a database of 113 patients with undilated pancreatic ducts who had undergone laparoscopic pancreaticoduodenectomy (LPD) with purse string suture pancreaticojejunostomy to analyze the perioperative outcomes. Results One hundred thirteen patients underwent successful LPD. The surgery time was 353 ± 41 min, the time required for pancreaticojejunostomy was 27 ± 5 min, and the hospital stay after surgery was 16 ± 8 days. Fifteen patients suffered postoperative complications, including twelve patients with pancreatic fistula, one with bile leakage, one with gastroparesis (complicated with abdominal infection), and one with abdominal bleeding. No perioperative death occurred. Conclusions Purse string suture pancreaticojejunostomy is safe and feasible for patients with an undilated pancreatic duct. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01640-w.
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Affiliation(s)
- Haihua Zhou
- Department of Hepatobiliary Surgery, The Affiliated Jinhua Hospital of Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Shian Yu
- Department of Hepatobiliary Surgery, The Affiliated Jinhua Hospital of Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
| | - Xiaokang Wu
- Department of Hepatobiliary Surgery, The Affiliated Jinhua Hospital of Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Xuemin Li
- Department of Hepatobiliary Surgery, The Affiliated Jinhua Hospital of Zhejiang University School of Medicine, Jinhua, Zhejiang, China
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Zhou Y, Yang J, Wei L, Lin Q, Zheng S, Liu G, Zhou Q, Tan X, Chen R. A novel anastomosis technique facilitates pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (with video). Langenbecks Arch Surg 2021; 406:2891-2897. [PMID: 34654961 DOI: 10.1007/s00423-021-02347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND While the best technique for pancreatic anastomosis during Whipple's procedure remains controversial, laparoscopic pancreaticoduodenectomy (LPD) has been rapidly increasing in popularity. Because of their feasibility and reliability, new pancreatic anastomosis techniques may have vital roles when adapted for LPD. Here, we describe a new pancreaticojejunostomy (PJ) technique using three sutures (termed the "three sutures" PJ technique), which facilitates pancreatic anastomosis during total LPD. METHODS A total of 149 patients who underwent LPD using the "three sutures" PJ technique at three hospitals were included in this study (81 patients at Guangdong Provincial People's Hospital [GDPH], 60 patients at Sun Yat-Sen Memorial Hospital [SMH], and 8 patients at Affiliated Hospital of Guangdong Medical University [AHGMU]). Data on the demographic characteristics, operative outcomes, and postoperative results (pancreatic fistula rate, mortality rate, and length of hospital stay) of these patients were collected and analyzed. RESULTS A surgical video showing the details of the "three sutures" PJ method was included. The mean operation times at GDPH, SMH, and AHGMU were 4.08 ± 0.99 h, 4.65 ± 1.53 h, and 4.67 ± 0.64 h, respectively, and the average PJ times were 17.96 ± 3.49 min, 18.19 ± 2.63 min, and 22.5 ± 3.96 min, respectively. The numbers of grade B pancreatic fistulas were 9 (11.11%), 2 (3.33%), and 1 (12.50%), respectively, and two patients had grade C fistulas, one each at GDPH and SMH. The numbers of clinically relevant postoperative pancreatic fistula (CR-POPF) were 10 (12.35%), 3 (5.00%), and 1 (12.50%) in each center, respectively. The overall rate of CR-POPF was 9.40% (14/149) among patients of all three centers. The perioperative mortality rate was 0%. CONCLUSIONS The "three sutures" PJ technique for total LPD is a safe and reliable method, with a low risk of pancreatic fistula, short anastomosis time, and steep learning curve.
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Affiliation(s)
- Yu Zhou
- Department of Pancreatic Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510120, China
| | - Jiabin Yang
- Department of Pancreatic Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510120, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong Province, China
| | - Lusheng Wei
- Department of Pancreatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Qing Lin
- Department of Pancreatic Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510120, China
| | - Shangyou Zheng
- Department of Pancreatic Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510120, China
| | - Guohua Liu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Quanbo Zhou
- Department of Pancreatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
| | - Xiaoyu Tan
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Rufu Chen
- Department of Pancreatic Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510120, China.
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El Khoury R, Kabir C, Maker VK, Banulescu M, Wasserman M, Maker AV. Do Drains Contribute to Pancreatic Fistulae? Analysis of over 5000 Pancreatectomy Patients. J Gastrointest Surg 2018; 22:1007-1015. [PMID: 29435899 DOI: 10.1007/s11605-018-3702-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/25/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Conflicting evidence exists from randomized controlled trials supporting both increased complications/fistulae and improved outcomes with drain placement after pancreatectomy. The objective was to determine drain practice patterns in the USA, and to identify if drain placement was associated with fistula formation. METHODS Demographic, perioperative, and patient outcome data were captured from the most recent annual NSQIP pancreatic demonstration project database, including components of the fistula risk score. Significant variables in univariate analysis were entered into adjusted logistic regression models. RESULTS Of 5013 pancreatectomy patients, 4343 (87%) underwent drain placement and 18% of patients experienced a pancreatic fistula. When controlled for other factors, drain placement was associated with ducts < 3 mm, soft glands, and blood transfusion within 72 h of surgery. Age, obesity, neoadjuvant radiation, preoperative INR level, and malignant histology lost significance in the adjusted model. Drained patients experienced higher readmission rates (17 vs. 14%; p < 0.05) and increased (20 vs. 8%; p < 0.01) pancreatic fistulae. Fistula was associated with obesity, no neoadjuvant chemotherapy, drain placement, < 3 mm duct diameter, soft gland, and longer operative times. Drain placement remained independently associated with fistula after both distal pancreatectomy (OR = 2.84 (1.70, 4.75); p < 0.01) and pancreatoduodenectomy (OR = 2.29 (1.28, 4.11); p < 0.01). CONCLUSIONS Despite randomized controlled clinical trial data supporting no drain placement, drains are currently placed in the vast majority (87%) of pancreatectomy patients from > 100 institutions in the USA, particularly those with soft glands, small ducts, and perioperative blood transfusions. When these factors are controlled for, drain placement remains independently associated with fistulae after both distal and proximal pancreatectomy.
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Affiliation(s)
- R El Khoury
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, 835 S. Wolcott St. MC790, Chicago, IL, USA.,Departments of Surgery and Research, Creticos Cancer Center and the Advocate Health Research Institute, Chicago, IL, USA
| | - C Kabir
- Departments of Surgery and Research, Creticos Cancer Center and the Advocate Health Research Institute, Chicago, IL, USA
| | - V K Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, 835 S. Wolcott St. MC790, Chicago, IL, USA.,Departments of Surgery and Research, Creticos Cancer Center and the Advocate Health Research Institute, Chicago, IL, USA
| | - M Banulescu
- Departments of Surgery and Research, Creticos Cancer Center and the Advocate Health Research Institute, Chicago, IL, USA
| | - M Wasserman
- Departments of Surgery and Research, Creticos Cancer Center and the Advocate Health Research Institute, Chicago, IL, USA
| | - A V Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, 835 S. Wolcott St. MC790, Chicago, IL, USA. .,Departments of Surgery and Research, Creticos Cancer Center and the Advocate Health Research Institute, Chicago, IL, USA.
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Sun X, Zhang Q, Zhang J, Lou Y, Fu Q, Zhang X, Liang T, Bai X. Meta-analysis of invagination and duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: An update. Int J Surg 2016; 36:240-247. [PMID: 27826046 DOI: 10.1016/j.ijsu.2016.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/30/2016] [Accepted: 11/03/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Duct-to-mucosa and invagination are two commonly used techniques of pancreaticojejunostomy (PJ) after pancreaticoduodenectomy. Previously, we conducted a systematic review comparing the safety and efficacy of the two PJ techniques. Here, we added new evidence and updated our previous conclusion. METHODS We systematically searched multiple databases and included randomized controlled trials (RCTs) comparing duct-to-mucosa and invagination techniques of PJ. The quality of evidence was assessed using Jadad score, and reporting bias was evaluated using funnel plots. Meta-analysis was performed using a random-effects model. Risk ratio (RR) and 95% confidence interval (CI) were calculated. The primary outcome was pancreatic fistula, and the secondary outcomes included mortality, reoperation, morbidity and postoperative hospital stay. Trial sequential analysis was performed to calculate the required information size. RESULTS Seven RCTs with 850 participants were included. No significant difference was detected in the rates of pancreatic fistula (RR 0.98, 95% CI 0.63 to 1.53), mortality (RR 0.94, 95% CI 0.40 to 2.18), reoperation (RR 1.23, 95% CI 0.69 to 2.20) and morbidity (RR 0.98, 95% CI 0.82 to 1.16) between the two groups. However, patients who underwent duct-to-mucosa PJ had a significantly shorter postoperative hospital stay (mean difference -2.80, 95% CI -5.08 to -0.52). Trial sequential analysis showed that another 279 participants were needed for conclusive results. CONCLUSIONS Given the current evidence, duct-to-mucosa PJ did not decrease the rates of pancreatic fistula and other adverse events as compared to invagination PJ; however, it did reduce postoperative hospital stay. Further RCTs are needed.
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Affiliation(s)
- Xu Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of General Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - JingYing Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Lou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - QiHan Fu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - XingLong Zhang
- The Second Department of General Surgery, People's Hospital of Kaihua, Quzhou, China
| | - TingBo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - XueLi Bai
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Miyamoto R, Oshiro Y, Nakayama K, Kohno K, Hashimoto S, Fukunaga K, Oda T, Ohkohchi N. Three-dimensional simulation of pancreatic surgery showing the size and location of the main pancreatic duct. Surg Today 2016; 47:357-364. [PMID: 27368278 DOI: 10.1007/s00595-016-1377-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/17/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE We performed three-dimensional (3D) surgical simulation of pancreatic surgery, including the size and location of the main pancreatic duct on the resected pancreatic surface. METHODS The subjects of this retrospective analysis were 162 patients who underwent pancreatic surgery. This cohort was sequentially divided into a "without-3D" group (n = 81) and a "with-3D" group (n = 81). We compared the pancreatic duct diameter and its location, using nine sections in a grid pattern, with the intraoperative findings. The perioperative outcomes were also compared between patients who underwent pancreaticoduodenectomy (PD) and those who underwent distal pancreatectomy (DP). RESULTS There were no significant differences in the main pancreatic duct diameter between the 3D-simulated values and the operative findings. The 3D-simulated main pancreatic duct location was consistent with its actual location in 80 % of patients (65/81). In comparing the PD and DP groups, the intraoperative blood loss was 1174 ± 867 and 817 ± 925 ml in the without-3D group, and 828 ± 739 and 307 ± 192 ml in the with-3D group, respectively (p = 0.024, 0.026). CONCLUSION The 3D surgical simulation provided useful information to promote our understanding of the pancreatic anatomy, including details on the size and location of the main pancreatic duct.
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Affiliation(s)
- Ryoichi Miyamoto
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Oshiro
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ken Nakayama
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Keisuke Kohno
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Hashimoto
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kiyoshi Fukunaga
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Oda
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nobuhiro Ohkohchi
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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