Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Kauffmann, Emanuele F., Napoli, Niccolò, Ginesini, Michael, Gianfaldoni, Cesare, Asta, Fabio, Salamone, Alice, Amorese, Gabriella, Vistoli, Fabio, Boggi, Ugo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
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
_version_ 1784828417318846464
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
work_keys_str_mv AT kauffmannemanuelef feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT napoliniccolo feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT ginesinimichael feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT gianfaldonicesare feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT astafabio feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT salamonealice feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT amoresegabriella feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT vistolifabio feasibilityofcoldtriangleroboticpancreatoduodenectomy
AT boggiugo feasibilityofcoldtriangleroboticpancreatoduodenectomy