Application of Robot-assisted Pancreaticobiliary Junction Resection in Benign Duodenal Tumors

Summary

The current protocol delineates the use of robot-assisted pancreaticobiliary junction resection for the surgical management of benign duodenal tumors. This approach provides an effective solution for treating these tumors while minimizing duodenal loss and reducing associated complications.

Abstract

Robot-assisted pancreaticobiliary junction resection is a surgical technique employed to treat benign duodenal tumors. The procedure involves several key steps: making a longitudinal incision in the duodenum, excising the tumor at the pancreaticobiliary junction, inserting a biliary stent, connecting the biliary and duodenal mucosa, and suturing the duodenal incision during phase I. The robotic system enhances visibility, facilitates precise operations, minimizes duodenal traction injuries to the duodenum and surgical trauma, ensures accurate suture and fixation of bile duct stents, connects the bile duct and duodenal mucosa and reduces postoperative recovery time. Given the complexity of the operation and the associated risk of postoperative duodenal fistula, a thorough preoperative evaluation and meticulous perioperative preparation are crucial. Prior to the procedure, a comprehensive assessment was conducted, integrating the patient's medical history, family history, serological tests, and imaging studies. Special emphasis was placed on determining the benign or malignant nature of the tumor and evaluating the status of the duodenal artery blood supply network to ascertain the feasibility and efficacy of the surgery. During the operation, efforts were made to minimize duodenal trauma and avoid compromising the duodenal artery blood supply network. Additionally, the use of bile duct stents was considered essential to prevent biliary strictures, facilitate bile discharge, and mitigate biliary complications. Postoperatively, real-time monitoring of amylase and jaundice indicators in drainage fluid informed the timely removal of drainage tubes in accordance with the enhanced recovery after surgery (ERAS) protocol. Subsequent follow-up indicated a successful recovery, characterized by a notable reduction in preoperative abdominal pain, the absence of long-term complications, and no evidence of tumor recurrence. Consequently, robot-assisted pancreaticobiliary junction resection demonstrates a safe and effective surgical approach for the treatment of benign duodenal tumors.

Introduction

Duodenal tumors are relatively rare, exhibiting a low incidence, and can be classified as benign or malignant. Primary duodenal tumors (PTD) are the most common, while secondary tumors are less frequent^1,2. Common benign tumors in the duodenum include adenoma, stromal cell tumor, lipoma, fibroma, and hemangioma, with adenoma being the most prevalent and possessing the potential for malignant transformation^3,4,5. The disease typically presents insidiously, with early stages often being asymptomatic or displaying non-sp....

Protocol

The operation is routine and has received ethical approval. The research content and methods meet the medical ethics norms and requirements. The Ethics Committee of the Six Affiliated Hospitals of Sun Yat-sen University approved this study. The patient provided written informed consent.

1. Patient selection

1. Use the following inclusion criteria: benign duodenal tumors, including adenoma, stromal cell tumor, lipoma, fibroma, and hemangioma.
2. Use the followin.......

Discussion

Duodenal benign tumors are infrequent in clinical practice, yet they can lead to severe complications^1,15,16. The choice of treatment depends on factors such as the size, location, and tissue type of the lesion. Given the relatively fixed position of the duodenum, which is often situated posterior to the peritoneum and closely associated with the head of the pancreas and the ampulla of the bile pancreatic duct, intraoperative bl.......

Materials

Name	Company	Catalog Number	Comments
Abdominal instrument button	Johnson & Johnson	/	/
Abdominal instrument cap	Johnson & Johnson	/	/
Abdominal instrument collar	Johnson & Johnson	/	/
Abdominal instrument connector	Johnson & Johnson	/	/
Barbs	Johnson & Johnson	/	/
Blade	Johnson & Johnson	/	/
Blood pad	Johnson & Johnson	/	/
Cloth towel forceps	Johnson & Johnson	/	/
Da Vinci robot (IV)	Intuitive Surgical, USA	/	/
Disposable drainage tube	Johnson & Johnson	412280	10 cm x 2.67 mm
Electric knife head	Johnson & Johnson	/	/
Forceps	Johnson & Johnson	/	/
Hilt	Johnson & Johnson	/	/
Holding flask	Johnson & Johnson	/	/
Intestinal forceps	Johnson & Johnson	/	/
Laparoscope	Johnson & Johnson	/	/
Laparoscopic instruments	Johnson & Johnson	/	/
Long curved forceps	Johnson & Johnson	/	/
Medium curved forceps	Johnson & Johnson	/	/
Needle holders	Johnson & Johnson	/	/
Ovoid forceps	Johnson & Johnson	/	/
Paraffin oil	Johnson & Johnson	/	/
Purse string forceps	Johnson & Johnson	/	/
Right angled forceps	Johnson & Johnson	/	/
Right angled forceps	Johnson & Johnson	/	/
Scissors	Johnson & Johnson	/	/
Siphonhead	Johnson & Johnson	/	/
Small cup	Johnson & Johnson	/	/
Small curved forceps	Johnson & Johnson	/	/
Sonotome keyhole	Johnson & Johnson	/	/
Steel ruler	Johnson & Johnson	/	/
Straight forceps	Johnson & Johnson	/	/
Suction needle plate	Johnson & Johnson	/	/
Suture needle	Johnson & Johnson	Vcp397H	/
Syringe	Johnson & Johnson	/	/
Syringe needle	Johnson & Johnson	/	/
Tissue forceps	Johnson & Johnson	/	/
Trocar(XCEL)	Ethicon Endo-Surgery	695C71	/
Ultrasonic knife spacers	Johnson & Johnson	/	/
Ultrasound knife	Johnson & Johnson	/	/
Yarn ball	Johnson & Johnson	/	/