南方医科大学学报2018，Vol.38Issue(2)：130-134,5.DOI:10.3969/j.issn.1673-4254.2018.02.02
机器人胰腺手术1010例经验与教训
A single-team experience with robotic pancreatic surgery in 1010 cases
摘要
Abstract
Objective To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases. Methods The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system. Results The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06％(41/1010), a blood transfusion rate of 6.7％ (68/1010), a mean post-operative stay of 10.87 ± 6.70 days, a complication rate (beyond grade Ⅲ according to Clavien-Dindo scoring system) of 8.0％ (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21％ (93/1010). The mortality rate of the patients was 0.69％ (7/1010) in 30 days and 1.31％ (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44％ in 2012 to 72.06％ in 2017. Conclusion This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.关键词
机器人手术/微创手术/胰腺/远端胰腺切除/胰十二指肠切除术Key words
robotic surgery/minimally invasive surgery/pancreas/distal pancreatectomy/pancreaticoduodenectomy引用本文复制引用
刘荣,张煊,赵国栋,唐文博,张柯迪,赵之明,高元兴,胡明根,李成刚,谭向龙..机器人胰腺手术1010例经验与教训[J].南方医科大学学报,2018,38(2):130-134,5.基金项目
国家自然科学基金(81500499) （81500499）
国家重点研发计划(2017YFC0110405) Supported by National Natural Science Foundation of China (81500499) and National Key Research and Development Program of China (2017YFC0110405). （2017YFC0110405）
