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Robot-Assisted Middle Pancreatectomy for Elderly Patients: Our Initial Experience.

Zhang T, Wang X, Huo Z, Wen C, Wu Z, Jin J, Cheng D, Chen H, Deng X, Shen B, Peng C - Med. Sci. Monit. (2015)

Bottom Line: The mean hospital stay was 19.91 days.It had low risk of exocrine or endocrine dysfunction and benefited patients' long-term outcomes.Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).

ABSTRACT

Background: The aim of this study was to evaluate the indications, safety, feasibility, and short- and long-term outcomes for elderly patients who underwent robot-assisted middle pancreatectomies (MPs).

Material and methods: Ten patients (≥60 years) underwent robot-assisted middle pancreatectomies from 2012 to 2015. The perioperative data, including tumor size, operating time, rate of postoperative pancreatic fistula (POPF), postoperative morbidity, and other parameters, were analyzed. We collected and analyzed the follow-up information.

Results: The mean age of patients was 64.30 years (range, 60-73 years). The average tumor size was 2.61 cm. The 10 cases were all benign or low-grade malignant lesions. The mean operating time was 175.00 min. The mean blood loss was 113.00 ml with no blood transfusion needed. Postoperative fistulas developed in 5 patients; there were 2 Grade A fistulas and 3 grade B fistulas. There were 3 patients who underwent postoperative complications, including 2 Grade 1 or 2 complications and 1 Grade 3 complication. No reoperation and postoperative mortality occurred. The mean hospital stay was 19.91 days. After a median follow-up of 23 months, new onset of diabetes mellitus developed in 1 patient and none suffered from deterioration of previously diagnosed diabetes or exocrine insufficiency, and no tumor recurrence happened.

Conclusions: Robot-assisted middle pancreatectomy was safe and feasible for elderly people. It had low risk of exocrine or endocrine dysfunction and benefited patients' long-term outcomes. Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.

No MeSH data available.


Related in: MedlinePlus

(A) Opening the gastrocolic ligament. (B) Pancreas exposure. (C) Vascular exposure at the superior edge of the pancreatic body. (D) SMV exposure at the inferior edge of the pancreatic body. SMV, superior mesenteric vein
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f2-medscimonit-21-2851: (A) Opening the gastrocolic ligament. (B) Pancreas exposure. (C) Vascular exposure at the superior edge of the pancreatic body. (D) SMV exposure at the inferior edge of the pancreatic body. SMV, superior mesenteric vein

Mentions: The ultrasonic scalpel was used to open the gastrocolic ligament (Figure 2A) and then we exposed the pancreas by lifting and retracting the posterior gastric wall by the fourth robotic arm (Figure 2B). Following this step, we generally could recognize the tumor and next exposed and dissected the portal vein (PV) at the superior edge of the pancreatic neck and the superior mesenteric vein (SMV) at the inferior edge of the neck of pancreas. Along with the vascular axis, the retropancreatic tunnel was carefully established (Figure 2C, 2D). Then, the pancreatic neck was transected using the ultrasonic scalpel. The proximal stump was intermittently sutured with polypropylene 4-0 for homeostasis and preventing POPF (Figure 3A). The distal pancreas was carefully dissected between the pancreas and the splenic vessels. Then, we transected the pancreas on the left side of the tumor with the ultrasonic scalpel. The distal pancreas was dissected about 2 or 3 cm for achieving pancreaticogastrostomy with no tension. We carried out 2-layer end-to-side pancreaticogastrostomy for reconstruction. First, we inserted a stent into the pancreatic tube for drainage, hoping to prevent the stenosis of anastomosis (Figure 3B) because it always increases the risk the POPF and pancreatitis [2]. Then the outer layer of posterior wall was performed with intermittent stitches of 4-0 Prolene sutures from the pancreatic parenchyma to the seromuscular layer (Figure 3C). After that, a 3–4 cm incision was made at the posterior wall of gastric body using the electric hook and the inner layer of the posterior wall was performed with intermittent stitches of 4-0 Prolene sutures from the stump of the pancreatic remnant to the full layer of the gastric body (Figure 3D). The anastomosis of the posterior wall was completed. Next, we inserted the stent into the gastric lumen and performed the anastomosis of the anterior wall in the same way (Figure 3E, 3F). Two drainage tubes were placed near the proximal pancreatic stump and the anastomosis.


Robot-Assisted Middle Pancreatectomy for Elderly Patients: Our Initial Experience.

Zhang T, Wang X, Huo Z, Wen C, Wu Z, Jin J, Cheng D, Chen H, Deng X, Shen B, Peng C - Med. Sci. Monit. (2015)

(A) Opening the gastrocolic ligament. (B) Pancreas exposure. (C) Vascular exposure at the superior edge of the pancreatic body. (D) SMV exposure at the inferior edge of the pancreatic body. SMV, superior mesenteric vein
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4588669&req=5

f2-medscimonit-21-2851: (A) Opening the gastrocolic ligament. (B) Pancreas exposure. (C) Vascular exposure at the superior edge of the pancreatic body. (D) SMV exposure at the inferior edge of the pancreatic body. SMV, superior mesenteric vein
Mentions: The ultrasonic scalpel was used to open the gastrocolic ligament (Figure 2A) and then we exposed the pancreas by lifting and retracting the posterior gastric wall by the fourth robotic arm (Figure 2B). Following this step, we generally could recognize the tumor and next exposed and dissected the portal vein (PV) at the superior edge of the pancreatic neck and the superior mesenteric vein (SMV) at the inferior edge of the neck of pancreas. Along with the vascular axis, the retropancreatic tunnel was carefully established (Figure 2C, 2D). Then, the pancreatic neck was transected using the ultrasonic scalpel. The proximal stump was intermittently sutured with polypropylene 4-0 for homeostasis and preventing POPF (Figure 3A). The distal pancreas was carefully dissected between the pancreas and the splenic vessels. Then, we transected the pancreas on the left side of the tumor with the ultrasonic scalpel. The distal pancreas was dissected about 2 or 3 cm for achieving pancreaticogastrostomy with no tension. We carried out 2-layer end-to-side pancreaticogastrostomy for reconstruction. First, we inserted a stent into the pancreatic tube for drainage, hoping to prevent the stenosis of anastomosis (Figure 3B) because it always increases the risk the POPF and pancreatitis [2]. Then the outer layer of posterior wall was performed with intermittent stitches of 4-0 Prolene sutures from the pancreatic parenchyma to the seromuscular layer (Figure 3C). After that, a 3–4 cm incision was made at the posterior wall of gastric body using the electric hook and the inner layer of the posterior wall was performed with intermittent stitches of 4-0 Prolene sutures from the stump of the pancreatic remnant to the full layer of the gastric body (Figure 3D). The anastomosis of the posterior wall was completed. Next, we inserted the stent into the gastric lumen and performed the anastomosis of the anterior wall in the same way (Figure 3E, 3F). Two drainage tubes were placed near the proximal pancreatic stump and the anastomosis.

Bottom Line: The mean hospital stay was 19.91 days.It had low risk of exocrine or endocrine dysfunction and benefited patients' long-term outcomes.Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).

ABSTRACT

Background: The aim of this study was to evaluate the indications, safety, feasibility, and short- and long-term outcomes for elderly patients who underwent robot-assisted middle pancreatectomies (MPs).

Material and methods: Ten patients (≥60 years) underwent robot-assisted middle pancreatectomies from 2012 to 2015. The perioperative data, including tumor size, operating time, rate of postoperative pancreatic fistula (POPF), postoperative morbidity, and other parameters, were analyzed. We collected and analyzed the follow-up information.

Results: The mean age of patients was 64.30 years (range, 60-73 years). The average tumor size was 2.61 cm. The 10 cases were all benign or low-grade malignant lesions. The mean operating time was 175.00 min. The mean blood loss was 113.00 ml with no blood transfusion needed. Postoperative fistulas developed in 5 patients; there were 2 Grade A fistulas and 3 grade B fistulas. There were 3 patients who underwent postoperative complications, including 2 Grade 1 or 2 complications and 1 Grade 3 complication. No reoperation and postoperative mortality occurred. The mean hospital stay was 19.91 days. After a median follow-up of 23 months, new onset of diabetes mellitus developed in 1 patient and none suffered from deterioration of previously diagnosed diabetes or exocrine insufficiency, and no tumor recurrence happened.

Conclusions: Robot-assisted middle pancreatectomy was safe and feasible for elderly people. It had low risk of exocrine or endocrine dysfunction and benefited patients' long-term outcomes. Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.

No MeSH data available.


Related in: MedlinePlus