METHODS: The posterior duodenal wall is dissected before reconstruction, and the hepatoduodenal ligament is severed to facilitate passive duodenal manipulation. A quarter-circumference incision is created centrally on the anterior wall of the duodenal stump to avoid excessive tension during anastomosis and to ensure an adequate anastomotic diameter. A small opening is established on the greater curvature of the remaining stomach, and the posterior walls of the stomach and duodenum are joined using a Linear stapler in the first fire. A V-shape is created, and two EndoWrist instruments (robotic first and fourth arms) are utilized to grip and extend the anastomosis diameter, completing the anastomosis with a shared hole closure using the Linear stapler. The robotic arms\' features improve the physiological integrity and stability of the BI reconstruction.
RESULTS: A total of 81 patients underwent RDG with INTACT from September 2020 to January 2024. The median age was 72 years (range: 31-91), with 49 males and 32 females. The median blood loss was 0 ml (range: 0-200 ml), and the median postoperative hospital stay was 8 days (range: 6-20 days). No cases required reanastomosis during surgery, and no postoperative anastomotic leakage, surgery-related reoperations, or anastomotic strictures were reported.
CONCLUSIONS: INTACT in RDG can be safely performed. The characteristics of the EndoWrist instruments helped in stabilizing the technique, making it a viable option in robotic-assisted surgeries.
方法:重建前解剖十二指肠后壁,切断肝十二指肠韧带以促进被动十二指肠操作。在十二指肠残端的前壁中央形成四分之一圆周切口,以避免吻合期间过度紧张并确保足够的吻合直径。在剩余胃的较大曲率上建立一个小开口,胃和十二指肠的后壁在第一次火灾中使用线性订书机连接。创建一个V形,和两个EndoWrist仪器(机器人第一和第四臂)被用来抓住和延长吻合直径,使用线性吻合器通过共用孔闭合完成吻合。机械臂的特征提高了BI重建的生理完整性和稳定性。
结果:从2020年9月至2024年1月,共有81例患者接受了RDG与INTACT。中位年龄为72岁(范围:31-91),男性49人,女性32人。中位失血量为0ml(范围:0-200ml),中位术后住院时间为8天(范围:6-20天)。手术期间没有病例需要再吻合,术后无吻合口漏,手术相关的再手术,或报告吻合口狭窄。
结论:RDG中的INTACT可以安全地进行。EndoWrist仪器的特性有助于稳定该技术,使其成为机器人辅助手术的可行选择。