Pancreaticoduodenectomy is considered one of the most difficult abdominal surgeries and it is associated to high morbidity and it was developed to remove benign and malignant tumours of the head of the pancreas as well as the periampullary regions. Due to the complicated anatomical location and three organ resections followed by anastomoses and possible vascular resection and reconstruction, various complications such as post operative pancreatic fistula or leaks, delayed gastric emptying, biliary leak, and hemorrhage can arise. The development and implementation of minimally invasive surgical techniques, that include laparoscopic and robotic surgery, has greatly impacted the outcomes of surgical operation by means of smaller incisions, better visualization, and magnified fields. Robotic surgery, however, has some advantages over laparoscopy such as 3-D camera that is controlled by the surgeon with high magnification capabilities, comfortable seating position, and wristed instrumentation. In this paper, using the recent available literature, we have comprehensively reviewed the feasibility, safety, and effectiveness of robotic pancreaticoduodenectomy by taking into consideration various intra-operative and post-operative outcomes, such as operative time, estimated blood loss, unplanned conversion to open surgery, and cost. Additionally, we have reviewed the important issue of the learning curve associated to robotic surgery and the possible future advancements in this field. The feasibility and safety of this procedure has been demonstrated in high volume centres, through the hands of expert surgeons. Nevertheless, more advancements, and trials are needed for a wider adaptation of this technique.
Pancreaticoduodenectomia è considerata una delle chirurgie addominali più difficili ed è associata a elevata morbilità ed è stata sviluppata per rimuovere tumori benigni e maligni della testa del pancreas e delle regioni periampollari. A causa della complessa localizzazione anatomica e delle tre resezioni di organi seguite da anastomosi e possibili resezioni e ricostruzioni vascolari, possono sorgere varie complicanze come fistola pancreatico-operatoria o perdite, svuotamento gastrico ritardato, perdite biliari ed emorragie. Lo sviluppo e l'implementazione di tecniche chirurgiche invasive minime, che includono la laparoscopia e la chirurgia robotica, hanno avuto un grande impatto sugli esiti dell'intervento chirurgico mediante incisioni più piccole, una migliore visualizzazione e campi ingranditi. La chirurgia robotica, tuttavia, presenta alcuni vantaggi rispetto alla laparoscopia, come una telecamera 3D controllata dal chirurgo con elevate capacità di ingrandimento, una posizione seduta confortevole e strumentazione articolata. In questo articolo, utilizzando la recente letteratura disponibile, abbiamo esaminato in modo esaustivo la fattibilità, la sicurezza e l'efficacia della pancreaticoduodenectomia robotica, prendendo in considerazione vari esiti intraoperatori e postoperatori, come il tempo operatorio, la perdita ematica stimata, la conversione non pianificata alla chirurgia aperta e il costo. Inoltre, abbiamo esaminato l'importante questione della curva di apprendimento associata alla chirurgia robotica e i possibili futuri sviluppi in questo campo. La fattibilità e la sicurezza di questa procedura sono state dimostrate in centri specializzati da chirurghi esperti. Tuttavia, sono necessari ulteriori progressi e studi per una più ampia adozione di questa tecnica.
Feasibility, Safety, and Effectiveness of Robotic Pancreaticoduodenectomy: A Comprehensive Analysis
MANSOUBI, MEHRGOL
2022/2023
Abstract
Pancreaticoduodenectomy is considered one of the most difficult abdominal surgeries and it is associated to high morbidity and it was developed to remove benign and malignant tumours of the head of the pancreas as well as the periampullary regions. Due to the complicated anatomical location and three organ resections followed by anastomoses and possible vascular resection and reconstruction, various complications such as post operative pancreatic fistula or leaks, delayed gastric emptying, biliary leak, and hemorrhage can arise. The development and implementation of minimally invasive surgical techniques, that include laparoscopic and robotic surgery, has greatly impacted the outcomes of surgical operation by means of smaller incisions, better visualization, and magnified fields. Robotic surgery, however, has some advantages over laparoscopy such as 3-D camera that is controlled by the surgeon with high magnification capabilities, comfortable seating position, and wristed instrumentation. In this paper, using the recent available literature, we have comprehensively reviewed the feasibility, safety, and effectiveness of robotic pancreaticoduodenectomy by taking into consideration various intra-operative and post-operative outcomes, such as operative time, estimated blood loss, unplanned conversion to open surgery, and cost. Additionally, we have reviewed the important issue of the learning curve associated to robotic surgery and the possible future advancements in this field. The feasibility and safety of this procedure has been demonstrated in high volume centres, through the hands of expert surgeons. Nevertheless, more advancements, and trials are needed for a wider adaptation of this technique.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/16051