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Feasibility of “cold” triangle robotic pancreatoduodenectomy
BACKGROUND: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652209/ https://www.ncbi.nlm.nih.gov/pubmed/35881243 http://dx.doi.org/10.1007/s00464-022-09411-7 |
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author | Kauffmann, Emanuele F. Napoli, Niccolò Ginesini, Michael Gianfaldoni, Cesare Asta, Fabio Salamone, Alice Amorese, Gabriella Vistoli, Fabio Boggi, Ugo |
author_facet | Kauffmann, Emanuele F. Napoli, Niccolò Ginesini, Michael Gianfaldoni, Cesare Asta, Fabio Salamone, Alice Amorese, Gabriella Vistoli, Fabio Boggi, Ugo |
author_sort | Kauffmann, Emanuele F. |
collection | PubMed |
description | BACKGROUND: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein. We herein aim to show the feasibility of “cold” triangle robotic pancreaticoduodenectomy (C-Tr-RPD) for pancreatic cancer (PDAC). METHODS: Cold dissection corresponds to sharp arterial divestment performed using only the tips of robotic scissors. After division of the gastroduodenal artery, triangle dissection begins by lateral-to-medial divestment of the CHA and anterior-to-posterior clearance of the right side of the celiac trunk. Next, after a wide Kocher maneuver, the origin of the SMA, and the celiac trunk are identified. After mobilization of the first jejunal loop and attached mesentery, the SMA is identified at the level of the first jejunal vein and is divested along the right margin working in a distal-to-proximal direction. Vein resection and reconstruction can be performed as required. C-Tr-RPD was considered feasible if triangle dissection was successfully completed without conversion to open surgery or need to use energy devices. Postoperative complications and pathology results are presented in detail. RESULTS: One hundred twenty-seven consecutive C-Tr-RPDs were successfully performed. There were three conversions to open surgery (2.3%), because of pneumoperitoneum intolerance (n = 2) and difficult digestive reconstruction. Thirty-four patients (26.7%) required associated vascular procedures. No pseudoaneurysm of the gastroduodenal artery was observed. Twenty-eight patients (22.0%) developed severe postoperative complications (≥ grade III). Overall 90-day mortality was 7.1%, declining to 2.3% after completion of the learning curve. The median number of examined lymph nodes was 42 (33–51). The rate of R1 resection (7 margins < 1 mm) was 44.1%. CONCLUSION: C-Tr-RPD is feasible, carries a risk of surgical complications commensurate to the magnitude of the procedure, and improves staging of PDAC. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09411-7. |
format | Online Article Text |
id | pubmed-9652209 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-96522092022-11-15 Feasibility of “cold” triangle robotic pancreatoduodenectomy Kauffmann, Emanuele F. Napoli, Niccolò Ginesini, Michael Gianfaldoni, Cesare Asta, Fabio Salamone, Alice Amorese, Gabriella Vistoli, Fabio Boggi, Ugo Surg Endosc Dynamic Manuscript BACKGROUND: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein. We herein aim to show the feasibility of “cold” triangle robotic pancreaticoduodenectomy (C-Tr-RPD) for pancreatic cancer (PDAC). METHODS: Cold dissection corresponds to sharp arterial divestment performed using only the tips of robotic scissors. After division of the gastroduodenal artery, triangle dissection begins by lateral-to-medial divestment of the CHA and anterior-to-posterior clearance of the right side of the celiac trunk. Next, after a wide Kocher maneuver, the origin of the SMA, and the celiac trunk are identified. After mobilization of the first jejunal loop and attached mesentery, the SMA is identified at the level of the first jejunal vein and is divested along the right margin working in a distal-to-proximal direction. Vein resection and reconstruction can be performed as required. C-Tr-RPD was considered feasible if triangle dissection was successfully completed without conversion to open surgery or need to use energy devices. Postoperative complications and pathology results are presented in detail. RESULTS: One hundred twenty-seven consecutive C-Tr-RPDs were successfully performed. There were three conversions to open surgery (2.3%), because of pneumoperitoneum intolerance (n = 2) and difficult digestive reconstruction. Thirty-four patients (26.7%) required associated vascular procedures. No pseudoaneurysm of the gastroduodenal artery was observed. Twenty-eight patients (22.0%) developed severe postoperative complications (≥ grade III). Overall 90-day mortality was 7.1%, declining to 2.3% after completion of the learning curve. The median number of examined lymph nodes was 42 (33–51). The rate of R1 resection (7 margins < 1 mm) was 44.1%. CONCLUSION: C-Tr-RPD is feasible, carries a risk of surgical complications commensurate to the magnitude of the procedure, and improves staging of PDAC. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09411-7. Springer US 2022-07-26 2022 /pmc/articles/PMC9652209/ /pubmed/35881243 http://dx.doi.org/10.1007/s00464-022-09411-7 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Dynamic Manuscript Kauffmann, Emanuele F. Napoli, Niccolò Ginesini, Michael Gianfaldoni, Cesare Asta, Fabio Salamone, Alice Amorese, Gabriella Vistoli, Fabio Boggi, Ugo Feasibility of “cold” triangle robotic pancreatoduodenectomy |
title | Feasibility of “cold” triangle robotic pancreatoduodenectomy |
title_full | Feasibility of “cold” triangle robotic pancreatoduodenectomy |
title_fullStr | Feasibility of “cold” triangle robotic pancreatoduodenectomy |
title_full_unstemmed | Feasibility of “cold” triangle robotic pancreatoduodenectomy |
title_short | Feasibility of “cold” triangle robotic pancreatoduodenectomy |
title_sort | feasibility of “cold” triangle robotic pancreatoduodenectomy |
topic | Dynamic Manuscript |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652209/ https://www.ncbi.nlm.nih.gov/pubmed/35881243 http://dx.doi.org/10.1007/s00464-022-09411-7 |
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