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Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application

Authors
 Ho Kyoung Hwang  ;  Chang Moo Kang  ;  Young Eun Chung  ;  Kyung Ah Kim  ;  Sung Hoon Choi  ;  Woo Jung Lee 
Citation
 Surgical Endoscopy , Vol.27(3) : 774-781, 2013 
Journal Title
 Surgical Endoscopy  
ISSN
 0930-2794 
Issue Date
2013
Abstract
BACKGROUND: Advanced and delicate laparoscopic techniques are usually required for safe and successful laparoscopic spleen-preserving distal pancreatectomy. The unique characteristics of robotic surgical system are thought to be useful for this minimally invasive procedure. METHODS: From September 2007 to May 2011, patients who underwent robot-assisted, spleen-preserving, distal pancreatectomy for benign and borderline malignant tumors of the pancreas were retrospectively reviewed. Perioperative clinicopathologic surgical outcomes were evaluated. RESULTS: Twenty-two patients were attempted for robot-assisted, spleen-preserving, distal pancreatectomy, and in 21 patients (95.5 %), the spleen was saved either by splenic vessels conservation (SVC; n = 17, 81 %) or by splenic vessels sacrifice (SVS; n = 4, 19 %). Seven patients were male and 15 were female with a mean age of 43.2 ± 15.2 years. Pathologic diagnosis included MCT in five patients, SCT in five, SPT in four, IPMT in three, NET in three, and other benign conditions in two. The mean operation time was 398.9 ± 166.3 min, but it gradually decreased as experiences were accumulated (Rsq = 0.223, p = 0.023). Intraoperative blood loss was 361.3 ± 360.1 ml, and intraoperative transfusion was required in four patients (18.1 %). A soft diet was given for 1.2 ± 0.4 days, and the length of hospital stay was 7.0 ± 2.4 days postoperatively. Clinically relevant pancreatic fistula was noted in two patients (9.1 %) but was successfully managed conservatively. Most patients (87.5 %) showed patency in conserved both splenic vessels, and only two patients (12.5 %) had partially or completely obliterated in splenic veins in the SVC-SpDP group. Partially impaired splenic perfusion was observed in one patient in the SVS-SpDP group. The perfusion defect area decreased without any clinical symptom after 4 months. CONCLUSIONS: The robotic surgical system is thought to be beneficial for improving the spleen-preservation rate in laparoscopic distal pancreatectomy. Robot-assisted approach can be chosen for patients who require spleen-preserving distal pancreatectomy.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86455
DOI
10.1007/s00464-012-2551-6
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
Yonsei Authors
강창무(Kang, Chang Moo) ; 김경아(Kim, Kyung Ah) ; 이우정(Lee, Woo Jung) ; 정용은(Chung, Yong Eun) ; 최승훈(Choi, Seung Hoon) ; 황호경(Hwang, Ho Kyoung)
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Full Text
http://link.springer.com/article/10.1007%2Fs00464-012-2551-6
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