[Show abstract][Hide abstract] ABSTRACT: Almost 10 years have passed since computer-aided, most commonly known as robotic surgery, has emerged gaining slowly but steadily its place within minimally invasive surgical procedures. Nevertheless, pancreatic surgeons only recently have started incorporating it into current practice.
In this 'how I do it' article, we describe our method for robotic distal splenopancreatectomy, focusing on its technical advantages, as well as its drawbacks. Furthermore, we describe some pitfalls commonly encountered during the procedure and we propose ways to avoid them.
Pancreatic robotic-assisted surgery is offering many practical advantages over the "classic" laparoscopic approach. Even though a difficult procedure to master, it may have the potential to establish the concept of minimally invasive surgery in areas where it is nonexistent as in pancreatic surgery.
Journal of Gastrointestinal Surgery 05/2010; 14(8):1326-30. DOI:10.1007/s11605-010-1214-y · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Precise and expedient localization of small pancreatic tumors during laparoscopic distal pancreatectomy can be difficult owing to the decreased tactile ability of laparoscopy and the homogenous appearance of the surrounding retroperitoneal fat. Precise localization of the lesion is critical to achieving adequate margins of resection while preserving as much healthy pancreas as possible. The objective in this study was to determine the effect of endoscopic tattooing of the distal pancreas on operative time.
We reviewed retrospectively 36 consecutive patients who had a laparoscopic distal pancreatectomy at our institution over a 4-year period (2006-2009). Ten patients underwent preoperative tattooing via an endoscopic transgastric technique using ultrasound guidance. The tattoo was performed using 2-4 cc of sterile purified carbon particles injected immediately proximal and anterior to the pancreatic lesion. Operative times were compared according to the presence of a tattoo.
The endoscopically placed tattoo was easily visible upon entering the lesser sac in all 10 patients at laparoscopy. Patients with a tattoo had a shorter operative time (median, 128.5 minutes; range, 53-180) compared with patients without a tattoo (median, 180 minutes; range, 120-240; P < .01). None of the tattoo group required repeat surgery, whereas 1 patient who was not tattooed required re-resection for a lesion missed in the initial specimen. There were no complications associated with the endoscopic ultrasound-guided tattoo.
Endoscopic ultrasound-guided tattooing of pancreas lesions before a laparoscopic distal pancreatectomy is safe and is associated with decreased operative time compared with nontattooed patients. This technique can allow for quick and precise localization of the lesion, allowing for optimal preservation of pancreas parenchyma and demarcating an appropriate line of resection.
Surgery 08/2010; 148(2):371-7. DOI:10.1016/j.surg.2010.04.008 · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The pancreas remains an organ for which routine laparoscopic resection is uncommon.
This is a review of all distal pancreatectomies performed between January 2003 and December 2009 at Memorial Sloan-Kettering Cancer Center. Variables were compared between laparoscopic and open groups in unmatched and matched analyses.
During the 7-year study period, 343 distal pancreatectomies were performed; 107 (31%) were attempted laparoscopically and 236 (69%) were performed open. The conversion rate was 30%. Laparoscopic patients were younger (median 60 vs 64 years, p < 0.0001), experienced less blood loss (median 150 vs 350 mL, p < 0.0001), longer operative times (median 163 vs 194 minutes, p < 0.0001), shorter hospital stay (median 5 vs 7 days, p < 0.0001), and had fewer postoperative complications (27% vs 40%, p = 0.03) than open patients. The rates of complications of grade 3 or greater (20% vs 20%, p = NS) and pancreatic leak (15% vs 13%, p = NS) were similar between laparoscopic and open groups. Patients having procedures that were converted had a higher body mass index (BMI) than patients who did not (28 vs 25, p = 0.035). Patients with converted resections experienced higher rates of complications of grade 3 or greater (36% vs 20%, p = 0.008) and pancreatic leaks (27% vs 13%, p = 0.03) than open patients. Compared with matched open patients, laparoscopic patients had longer operative times (195 minutes vs 160 minutes, p < 0.0001), less blood loss (175 mL vs 300 mL, p < 0.0001), and shorter hospital stay (5 days vs 6 days, p < 0.001).
Patients who had laparoscopic distal pancreatectomy experienced decreased blood loss and a shorter hospital stay compared with matched patients undergoing open resection. Careful patient selection is important because patients who required conversion experienced higher rates of complications and pancreatic leak.
Journal of the American College of Surgeons 10/2010; 211(4):503-9. DOI:10.1016/j.jamcollsurg.2010.06.010 · 5.12 Impact Factor
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