RESUMEN
Pancreatoduodenectomy (PD) is considered as a complex and difficult surgical procedure even to the experi-enced surgeons, and it is thought to be the last frontier for mini-really invasive surgeons. Laparoscopic PD, despite the initial enthusiasm towards it, discourages laparoscopic surgeons by its long operating time and procedure-related fatigue resulting from technical difficulties associated with laparoscopic instruments and unstable camera platform. Although robotic surgical system with its known advantages has successfully overcome the limita-tions of traditional laparoscopic surgery, and completed the com-plex and advanced surgical procedures required in PD, reports on robot-assisted (laparobotic) PD remain few. Furthermore, there has not yet been a single report detailing PD techniques modified to take advantage of the Da Vinci platform. In this report, laparobotic PD was successfully performed on 7 patients. Five patients underwent pyloric preserving PD and 2 had stand-ard PD. All the 7 patients have been followed up till January 2009. The overall mean operative time was 326 minutes (290-400 minutes) and the mean length of postoperative stay was 10.2 days (5-30 days). There was no mortality. Five patients had perioperative complications but went on well after manage-ment. The stepwise cando-cranial approach PD is a unique approach, which is ideal for robotic platform. Although it has been shown to be feasible, safe, efficient, and reproducible in this small series, a larger scale multi-institutional study is needed to validate its efficacy.
RESUMEN
Objective To investigate the value of modified pancreatoduodenectomy in the treatment of ampullary carcinoma by comparing the efficacy of pancreatoduodenectomy with preservation of ascending portion of duodenum and that of Whipple procedure. Methods The clinical data of 133 patients with ampullary carcinoma who had been admitted to the Qilu Hospital from 1990 to 2006 were retrospectively analyzed. Of the 133 patients, 88 received Whipple procedure (group A) and 45 received pancreatoduedenectomy with preservation of ascending portion of duodenum (group B). The preoperative condition of the patients and short- and long-term efficacy of the 2 procedures were compared by Fisher exact probability, t test, chi-square test, Kaplan-Meier survival curve and Log-rank test, and the differences between the efficacy of the 2 procedures were compared. Results The operation time, time of gastrointestinal function recovery, hospital stay and ratio of patients with blood transfusion were (366±111) minutes, (7.4±1.4) days, (24±9) days and 76% (67/88) in group A, and (325±32)minutes, (4.3±1.4)days, (31±14)days, 42% (19/45) in group B, with significant difference between the 2 groups (t = 2.34, 2.08, 1.98 ; χ2 = 14.99, P < 0.05). The medium survival time of patients in groups A and B were (19.0±1.5)months and (16.9±1.7) months, with no significant difference between the 2 groups (χ2 = 0.46, P > 0.05). There was no significant difference in the occurrence of postoperative complications between the 2 groups (P > 0.05). Conclusions Pancreateduodenectomy with preservation of ascending portion of duodenum can be applied for patients with ampullary carcinoma.