Abstract：
Introduction: Pancreaticoduodenectomy, commonly known as the Whipple procedure, is a complex surgical technique employed for the treatment of various pancreatic and periampullary pathologies. Minimally invasive PD was created in an attempt to enhance the outcomes of the traditional, open technique. However, the reconstruction phase has been recognized as a substantial barrier to widespread adoption of the laparoscopic technique. Several research appraisals and case studies recommend the robotic technique as a facilitator during the reconstruction steps. We propose a hybrid approach to combine the versatility of laparoscopy and the visual and motor advantages of the DaVinci Xi in order to maximize the precision of the reconstruction. Our suggestion is based on the experience that our institution has had with the standardization of different surgical procedures and protocols. Methods This article is focused on the outcomes of robotic assisted PD in our institution. Eleven patients underwent robotic assisted laparoscopic PD between 1st January, 2020 and 7th March, 2023 (N=11). There were two approaches involved: hybrid PD type A (N=6) and hybrid PD type B (N=5). Results Of the eleven patients who underwent hybrid PD, most of them were men (81.8%) and mean age was 61.9 years-old (range 45 to 75 years). The mean operative duration was 618 minutes (range 480 to 780 minutes). Mean blood loss was 159 mL (range 50 to 350 mL). Ten operations were performed for malignancy and one for neuroendocrine duodenal tumour; the mean number of lymph nodes retrieved was 16.2 (range 11 to 24 nodes) and all the specimens were reported by pathology as R0. Mean hospital stay was 18 days (range 8 to 40 days). Reoperations were necessary in five patients (N=5), all from the type A group, and mortality occurred in one (N=1) patient. There were no conversions to open surgery during the index procedures as well as no clinically relevant postoperative pancreatic fistulae. Thirty-day mortality was nil, with 1 mortality at 90-days due to massive pulmonary embolism. Conclusions The hybrid approach facilitates the advantages of both laparoscopic and robotic approaches. While laparoscopy is safer in manipulating the bowel and allows the Roux en Y reconstruction and gastro-pancreatic anastomosis, the robotic assistance enables the surgeon to perform delicate anastomosis with a high accuracy. The learning curve\'s most important element is standardization and careful patient selection along with a stepwise approach.
摘要：
简介：胰十二指肠切除术，通常被称为Whipple程序，是一种复杂的外科技术，用于治疗各种胰腺和壶腹周围病变。微创PD的创建是为了增强传统的结果，开放技术。然而,重建阶段已被认为是广泛采用腹腔镜技术的实质性障碍。一些研究评估和案例研究建议在重建步骤中将机器人技术作为促进者。我们提出了一种混合方法，将腹腔镜的多功能性与达芬奇Xi的视觉和运动优势相结合，以最大程度地提高重建的精度。我们的建议是基于我们机构在标准化不同外科手术和方案方面的经验。方法本文重点介绍本机构机器人辅助PD的结果。11例患者在1月1日之间接受了机器人辅助腹腔镜PD，2020年3月7日，2023年（N=11）。涉及两种方法：混合PDA型（N=6）和混合PDB型（N=5）。结果在11例接受混合PD的患者中，其中大多数为男性(81.8%),平均年龄为61.9岁(45~75岁).平均手术时间为618分钟（范围为480至780分钟）。平均失血量为159mL（范围为50至350mL）。对恶性肿瘤进行了十次手术，对神经内分泌十二指肠肿瘤进行了一次手术；检索到的平均淋巴结数为16.2（范围为11至24个淋巴结），所有标本均通过病理学报告为R0。平均住院时间为18天（范围为8至40天）。5例患者需要再次手术（N=5），全部来自A型组，1例（N=1）患者死亡。在索引程序中没有转换为开放手术，也没有临床相关的术后胰瘘。30天死亡率为零，由于大面积肺栓塞，90天1例死亡。结论混合方法有利于腹腔镜和机器人方法的优点。虽然腹腔镜在操纵肠道时更安全，并允许RouxenY重建和胃胰腺吻合，机器人辅助使外科医生能够高精度地进行精细吻合。学习曲线最重要的因素是标准化和仔细的患者选择以及逐步的方法。
