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Azagra JS, Rosso E, Pascotto B, de Blasi V, Henrard A, González González L. Real robotic total mesopancreas excision (TMpE) assisted by hanging manoeuver (HM): Standardised technique. Int J Med Robot 2021; 17:e2259. [PMID: 33825351 DOI: 10.1002/rcs.2259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/06/2021] [Accepted: 04/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is one of the most demanding interventions for digestive surgeons. R0 resection is a key point for the overall survival and disease-free survival. Total mesopancreas excision (TMpE) has been described by laparotomy but laparoscopy did not provide good results probably because of the technical difficulties of the approach. We propose a standardised total robotic approach. METHODS In this step-by-step technical description, we propose as example, a case of a 53-year-old man with a pancreatic head adenocarcinoma with doubts about the invasion of the mesopancreas surrounding superior mesenteric artery. The mesopancreas hanging manoeuver allows us to perform a TMpE. RESULTS The surgery performed was a robotic artery first pancreaticoduodenectomy with TMpE. The pathological result was pancreatic ductal adenocarcinoma pT2, N1 (1/23), M0, V0, L0, Pn0, R0. CONCLUSIONS Robotic approach is safe, effective and reproductible. Through a standardised technique, it may overcome some of the technical difficulties of laparoscopic PD.
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Affiliation(s)
- Juan Santiago Azagra
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Edoardo Rosso
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Beniamino Pascotto
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Vito de Blasi
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Alexandre Henrard
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Lucia González González
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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Al-Sadairi AR, Mimmo A, Rhaiem R, Esposito F, Rached LJ, Tashkandi A, Zimmermann P, Memeo R, Sommacale D, Kianmanesh R, Piardi T. Laparoscopic hybrid pancreaticoduodenectomy: Initial single center experience. Ann Hepatobiliary Pancreat Surg 2021; 25:102-111. [PMID: 33649262 PMCID: PMC7952661 DOI: 10.14701/ahbps.2021.25.1.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023] Open
Abstract
Backgrounds/Aims Pancreaticoduodenectomy (PD) is the gold standard for the treatment of periampullary tumors. Many specialized centers have adopted the totally laparoscopic or hybrid laparoscopic PD (LPD). However, this procedure has not yet been standardized and serious debate is taking place towards its safety and feasibility. Herein, we report our recent experience whit hybrid-LPD. Methods During 2019 in our department 56 PD were performed and 21 (37.5%) underwent hybrid-LPD. We have retrospectively reviewed the short-term outcomes of these patients. Results Main indication was pancreatic adenocarcinoma (71,4%). The median operative time and intraoperative blood loss were respectively 425 min (range, 226 to 576) and 317 ml (range 60 to 800 ml). Conversion to an open procedure was required in 4 patients (19%): 2 with suspected vein involvement, 1 for mesenteric panniculitis and 1 for biliary injury. The post-operative complication rate was 42.8% (9/21). Regarding post-operative pancreatic fistula, three patients (14.2%) had grade B and 1 grade C (4.7%). Median length of hospital stay was 14 days (range 9-23) and 90- days mortality was 4.7%. The mean number of harvested lymph nodes was 17.7 (range 12 to 26). The rate of margins R0 was 80%; R1 >0<1 mm was 10.5% and R1 0 mm was 9.5%. Conclusions Hydrid-LPD is safe and feasible. Careful patient selection and increasing experience can reduce the risk of post-operative complications.
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Affiliation(s)
- Abdul Rahman Al-Sadairi
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Antonio Mimmo
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Francesco Esposito
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Linda J Rached
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Ahmad Tashkandi
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France.,Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Perrine Zimmermann
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Daniele Sommacale
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor University Hospital, AP-HP, Université Paris-Est Créteil (UPEC), France
| | - Reza Kianmanesh
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France
| | - Tullio Piardi
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France.,Hepato-Pancreato-Biliary Unit, General Surgery Department, Simone Veil Hospital, Troyes, University of Champagne-Ardenne, Reims, France
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Tips and tricks for a safe laparoscopic pancreatoduodenectomy. Wideochir Inne Tech Maloinwazyjne 2020; 15:383-390. [PMID: 32904617 PMCID: PMC7457202 DOI: 10.5114/wiitm.2020.97977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
Minimally invasive pancreatoduodenectomy has been revolutionized during the last decades and, although not as rapidly or widely adopted, the laparoscopic approach seems to be feasible with various potential advantages compared to traditional open pancreatoduodenectomy. Laparoscopic pancreatoduodenectomy is a technically demanding procedure with a steep learning curve mainly due to the fact that the technique is not standardized. Technical details as well as tips and tricks of the operation are described. Standardization of the procedure is the cornerstone of the learning curve of minimally invasive pancreatoduodenectomy. One of the largest barriers of this complex procedure is the reconstruction phase with the creation of three separate anastomoses. A hybrid approach may help surgeons – especially during the initial phase of the learning curve – to overcome the difficulties associated with a fully laparoscopic reconstruction, while retaining the advantages of laparoscopy.
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