Name: application of end-to-end anastomosis in robotic central pancreatectomy
Uploaded: 2018-06-02T13:30:00
Description: Watch this Scientific Journal Video about Application of End-to-end Anastomosis in Robotic Central Pancreatectomy at JoVE.com

作者没有确认。

从病人那里获得书面知情同意, 以便发表本报告以及随附的视频和图像。
1. 术前准备
<ol><li>仔细评估 CT 或 MRI 对肿瘤的确切位置及其与周围组织的关系的术前图像。</li>
	<li>在手术前一天给病人一个软饮食, 在手术前的午夜开始禁食。</li>
	<li>把病人放在手术台上。然后, 放置一个外周静脉导管, 并通过标准程序诱发全身麻醉。介绍一种中心静脉导管, 通过右颈内静脉的药物治?...

<ol>
	<li>Goudard, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reappraisal+of+central+pancreatectomy+a+12-year+single-center+experience.">Reappraisal of central pancreatectomy a 12-year single-center experience.</a> JAMA Surg. 149 (4), 356-363 (2014).</li><li>Iacono, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+of+central+pancreatectomy+and+meta-analysis+of+central+versus+distal+pancreatectomy.">Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy.</a> Br J Surg. 100 (7), 873-885 (2013).</li><li>Sperti, C., Beltrame, V., Milanetto, A. C., Moro, M., Pedrazzoli, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Parenchyma-sparing+pancreatectomies+for+benign+or+border-line+tumors+of+the+pancreas.">Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas.</a> World Journal of Gastrointestinal Oncology. 2 (6), 272-281 (2010).</li><li>Kim, D. H., Kang, C. M., Lee, W. J., Chi, H. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+central+pancreatectomy+with+pancreaticogastrostomy+(transgastric+approach)+in+a+solid+pseudopapillary+tumor+of+the+pancreas.">Robotic central pancreatectomy with pancreaticogastrostomy (transgastric approach) in a solid pseudopapillary tumor of the pancreas.</a> Hepato-gastroenterology. 58 (110-111), 1805-1808 (2011).</li><li>Addeo, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+central+pancreatectomy+with+stented+pancreaticogastrostomy:+operative+details.">Robotic central pancreatectomy with stented pancreaticogastrostomy: operative details.</a> The international journal of medical robotics + computer assisted surgery: MRCAS. 7 (3), 293-297 (2011).</li><li>Abood, G. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic-assisted+minimally+invasive+central+pancreatectomy:+technique+and+outcomes.">Robotic-assisted minimally invasive central pancreatectomy: technique and outcomes.</a> J Gastrointest Surg. 17 (5), 1002-1008 (2013).</li><li>Schwarz, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+Laparoscopic+Central+Pancreatectomy+with+Pancreaticogastrostomy+for+High-Risk+Cystic+Neoplasm.">Total Laparoscopic Central Pancreatectomy with Pancreaticogastrostomy for High-Risk Cystic Neoplasm.</a> Annals of surgical oncology. 23 (3), 1035 (2016).</li><li>Topal, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pancreaticojejunostomy+versus+pancreaticogastrostomy+reconstruction+after+pancreaticoduodenectomy+for+pancreatic+or+periampullary+tumours:+a+multicentre+randomised+trial.">Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial.</a> The Lancet Oncology. 14 (7), 655-662 (2013).</li><li>Lemaire, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+and+morphological+changes+in+the+pancreatic+remnant+following+pancreaticoduodenectomy+with+pancreaticogastric+anastomosis.">Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis.</a> Br J Surg. 87 (4), 434-438 (2000).</li><li>Rault, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pancreaticojejunal+Anastomosis+Is+Preferable+to+Pancreaticogastrostomy+after+Pancreaticoduodenectomy+for+Longterm+Outcomes+of+Pancreatic+Exocrine+Function.">Pancreaticojejunal Anastomosis Is Preferable to Pancreaticogastrostomy after Pancreaticoduodenectomy for Longterm Outcomes of Pancreatic Exocrine Function.</a> Journal of the American College of Surgeons. 201 (2), 239-244 (2005).</li><li>Lai, E. C., Tang, C. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+distal+pancreatectomy+versus+conventional+laparoscopic+distal+pancreatectomy:+a+comparative+study+for+short-term+outcomes.">Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.</a> Frontiers of medicine. 9 (3), 356-360 (2015).</li><li>Konstantinidis, I. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+total+pancreatectomy+with+splenectomy:+technique+and+outcomes.">Robotic total pancreatectomy with splenectomy: technique and outcomes.</a> Surg Endosc. , (2017).</li><li>Liu, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+surgical+outcomes+of+robot-assisted+laparoscopic+pancreaticoduodenectomy+versus+laparoscopic+pancreaticoduodenectomy+for+periampullary+neoplasms:+a+comparative+study+of+a+single+center.">The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center.</a> Surg Endosc. 31 (6), 2380-2386 (2017).</li><li>Lui, R., Zhao, G., Yin, Z., Zhao, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+enucleation+for+pancreatic+neoplasm+with+interposition+repair+of+the+main+pancreatic+duct:+a+case+report.">Robotic enucleation for pancreatic neoplasm with interposition repair of the main pancreatic duct: a case report.</a> Chinese Journal of Laparoscopic Surgery. 9 (6), 373-374 (2016).</li><li>Ehrhardt, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ueber+Resektionen+am+Pankreas1.">Ueber Resektionen am Pankreas1.</a> DMW-Deutsche Medizinische Wochenschrift. 34, 595-597 (1908).</li><li>Wolk, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+central+pancreatectomy+and+pancreatic+enucleation+as+pancreatic+resections--A+comparison.">Evaluation of central pancreatectomy and pancreatic enucleation as pancreatic resections--A comparison.</a> Int J Surg. 22, 118-124 (2015).</li><li>Ishii, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remnant+pancreas+reconstruction+with+duct-to-duct+anastomosis+after+middle+pancreatectomy:+a+report+of+two+cases.">Remnant pancreas reconstruction with duct-to-duct anastomosis after middle pancreatectomy: a report of two cases.</a> Hepato-gastroenterology. 62 (137), 190-194 (2015).</li><li>Di Benedetto, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meso-pancreatectomy:+new+surgical+technique+for+Wirsung+reconstruction.">Meso-pancreatectomy: new surgical technique for Wirsung reconstruction.</a> J Am Coll Surg. 214 (2), 1-4 (2012).</li><li>Oida, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=End-to-end+anastomosis+after+medial+pancreatectomy+for+tumor.">End-to-end anastomosis after medial pancreatectomy for tumor.</a> Hepato-gastroenterology. 54 (76), 1266-1268 (2007).</li><li>Ramesh, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=End-to-end+anastomosis+of+pancreas.">End-to-end anastomosis of pancreas.</a> Surgery. 131 (6), 691-693 (2002).</li><li>Kang, C. 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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+Central+Pancreatectomy+with+Pancreaticojejunostomy+for+Solid+Pseudopapillary+Neoplasm.">Robotic Central Pancreatectomy with Pancreaticojejunostomy for Solid Pseudopapillary Neoplasm.</a> Journal of Minimally Invasive Surgery. 20 (2), 74-76 (2017).</li><li>Ronnekleiv-Kelly, S. M., Javed, A. A., Weiss, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+central+pancreatectomy+and+pancreatogastrostomy+current+surgical+technique+and+outcomes.">Minimally invasive central pancreatectomy and pancreatogastrostomy current surgical technique and outcomes.</a> The Journal of Visualized Surgery. 2 (8), (2016).</li><li>Liu, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+versus+laparoscopic+distal+pancreatectomy:+A+propensity+score-matched+study.">Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study.</a> Journal of surgical oncology. 116 (4), 461-469 (2017).</li></ol>

恶性肿瘤位于胰颈和胰体近端, 常以胰十二指肠切除或远端胰腺治疗。然而, 对于良性或低恶性潜在肿瘤的那些部位, 标准的胰十二指肠切除术或远端胰腺将清除过多的正常组织, 并导致过度的伤害。因此, 中央胰腺或胰腺摘除, 称为 "实质保留胰腺", 成为治疗良性和低恶性潜在肿瘤的胰腺颈部和身体的首选选择。
早在 1908, Ehrhardt 报告了中央胰腺15。目前, 最常?...

中央胰腺正在越来越多地进行治疗的良性或低恶性潜在肿瘤位于胰腺颈部或近端的胰腺体1。与胰十二指肠切除或远端胰腺相比, 中枢胰腺切除掉组织少, 保存胰腺实质和功能。目前, 胰腺重建的主要方法是过度缝合头胰残端, 并执行 pancreaticojejunostomy 或 pancreaticogastrostomy 到远端残端2,3。这两种方法广泛应用于开放, 腹腔镜和机器人中心 pancreatectomies4,5,6,7。然而, 上述两种重建方法打破了消化道的解剖连续性和胰腺液排泄的途径。胰残端与肠道果汁直接接触可能增加出血和瘘管的可能性8。虽然胃液可以不活跃的胰腺酶, 以避免吻合的侵蚀, 它可能导致胰腺外分泌不足, 并长期危害患者的营养状况9,10。
随着微创手术的发展, 机器人手术在其3维放大视图、稳定性和运动灵活性、等等方面显示了巨大的优势, 为吻合术提供了增强的解剖缝合能力和止血11,12。根据我们在机器人胰腺和修复受伤的胰管的经验13,14, 我们已经执行了一系列的机器人中心胰腺端到端吻合, 看到良好的结果。与 pancreaticojejunostomy 或 pancreaticogastrostomy 相比, 端到端胰腺吻合避免了消化道损伤;因此, 理论上减少了 pancreaticoenteric 瘘的可能性。但另一方面, 端到端的胰腺吻合造成了更大的技术困难。作为常规中央胰腺的更新, 常规中央胰腺的候选者也有资格参加这项手术。在此, 我们介绍了在本视频案例演示中, 在第三个 hepatopancreatobiliary 中心进行端到端吻合的机器人中心胰腺的操作技术。
迹象：
(1) 位于胰颈及近体的良、低恶性电位肿瘤适用于本手术。 (2) 主胰管的缺损在中央胰腺后应小于5厘米, 肿瘤大小不是重建的主要关注。
案例演示:
病人是一名31岁的男子。2年前在一次体检中无意中发现了胰腺颈部的病变。他进行了定期复查, 发现病灶最近 asymptomatically 扩大。他以前没有做过腹部手术的病史。在体检中, 没有积极的迹象存在。胰腺 MRI 表现为大约14毫米的胰腺颈部的准圆形病变;这被推定为神经内分泌肿瘤。在 T1 和 T2-weighted 成像方面, 病灶分别显示 hypointense 和 hyperintense 信号。在扩散加权成像中, 病灶显示 hyperintense 信号。病变在动脉期略有增强, 在实质阶段和延迟阶段显示了渐进增强模式 (图 1)。重度脂肪肝也由 MRI 诊断。胰管未发现扩张或狭窄。常规血液检查、IgG 异构体试验、肿瘤生物标志物、心电图和胸部 x 线均正常。生化试验显示, 在 53.9U/l 的 147.3 U/升和 AST (天门冬氨酸转氨酶) 轻微升高, 可能是由脂肪肝引起。

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	<tbody>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">da Vinci Robotic Surgical System</td>
			<td style="width:296px;">Intuitive&#160;Surgical, USA</td>
			<td style="width:113px;">Si</td>
			<td style="width:159px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">EndoWrist Permanent Cautery Hook</td>
			<td>Intuitive&#160;Surgical, USA</td>
			<td style="width:113px;">420183</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">Harmonic Ace Curved Shears</td>
			<td>Ethicon, USA</td>
			<td style="width:113px;">420275</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">EndoWrist Large needle Driver</td>
			<td>Intuitive&#160;Surgical, USA</td>
			<td style="width:113px;">420006</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">EndoWrist Cadiere Forceps</td>
			<td>Intuitive&#160;Surgical, USA</td>
			<td style="width:113px;">420049</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">EndoWrist Black Diamond Micro Forceps</td>
			<td>Intuitive&#160;Surgical, USA</td>
			<td style="width:113px;">420033</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Lapro-Clip 8 mm Absorbable Clips</td>
			<td>Covidien&#160; , USA</td>
			<td style="width:113px;">8886848882</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">5-0 non-absorbable suture</td>
			<td>Ethicon, USA</td>
			<td style="width:113px;">M8717</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">4-0 non-absorbable suture</td>
			<td>Ethicon, USA</td>
			<td style="width:113px;">D9775</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">5-0 absorbable suture</td>
			<td>Ethicon, USA</td>
			<td style="width:113px;">D9943</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">Absorbable hemostas</td>
			<td>Ethicon, USA</td>
			<td style="width:113px;">W1912</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Laparoscopic Ultrasound Probe</td>
			<td>BK Ultrasound, Denmark</td>
			<td style="width:113px;">8666-RF</td>
			<td>transducer contact surface: 30*5mm; Frequence: 4.3-10 MHz</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">Pancreatic stent</td>
			<td>Yaxin Medical, Suzhou, China</td>
			<td style="width:113px;">1.2 mm&#160;</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Antibiotics&#160;(ceftriaxone sodium for injection)</td>
			<td style="width:296px;">Roche, Shanghai, China</td>
			<td style="width:113px;">H10983036</td>
			<td>ceftriaxone sodium (2g) adding to normal saline (100ml), once per day.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Proton pump inhibitors (lansoprazole injection)&#160;</td>
			<td style="width:296px;">Luoxin Pharmaceutical, Linyi, China</td>
			<td style="width:113px;">H20055118</td>
			<td>lansoprazole injection (30 mg) adding to normal saline (100ml), twice per day.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Somatostatin (Somatostatin for injection)</td>
			<td style="width:296px;">Merck Serono, Germany</td>
			<td style="width:113px;">H20090929</td>
			<td>Somatostatin for injection (6000ug) adding to nornal saline to a total of 48ml, 2 ml/h</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">Analgesic</td>
			<td style="width:296px;"></td>
			<td style="width:113px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Analgesic (sufentanil Citrate injection)</td>
			<td style="width:296px;">Humanwell Healthcare, Fuzhou, China</td>
			<td style="width:113px;">H20054171</td>
			<td>sufentanil Citrate (200ug),&#160; Ondansetron hyrochloride (20mg), adding to normal saline to a total of 80 ml, 1 ml/h</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Analgesic (Ondansetron hyrochloride injection)</td>
			<td style="width:296px;">Qilu Pharmaceutical, Hainan, China</td>
			<td style="width:113px;">H10970065</td>
			<td>sufentanil Citrate (200ug),&#160; Ondansetron hyrochloride (20mg), adding to normal saline to a total of 80 ml, 2 ml/h</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:205px;">Parenteral nutrition&#160;</td>
			<td style="width:296px;"></td>
			<td style="width:113px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(10% glucose injection)</td>
			<td style="width:296px;">Shijiazhuang No.4 Pharmaceutical&#65292;Shijiazhuang, China</td>
			<td style="width:113px;">H20133313</td>
			<td>1000 ml</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(5% glucose&#160; injection)</td>
			<td style="width:296px;">Shijiazhuang No.4 Pharmaceutical&#65292;Shijiazhuang, China</td>
			<td style="width:113px;">H13022474</td>
			<td style="width:159px;">250 ml</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(Compond vitamin injection)</td>
			<td style="width:296px;">Pude Pharmaceutical, Datong, China</td>
			<td style="width:113px;">H20093720</td>
			<td style="width:159px;">1 piece</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(Compond amino acid injection)</td>
			<td style="width:296px;">Kelun Pharmaceutical, Chengdu, China</td>
			<td style="width:113px;">H20066058</td>
			<td style="width:159px;">500 ml</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutritionz(Fat emulsion injection)</td>
			<td style="width:296px;">Fresenius Kabi AB, Sweden</td>
			<td style="width:113px;">H20160019</td>
			<td style="width:159px;">250 ml</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(10%KCl injection)</td>
			<td style="width:296px;">Jinyao Pharmaceutical, Tianjin, China</td>
			<td style="width:113px;">H12020518</td>
			<td style="width:159px;">50 ml</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(10%NaCl injection)</td>
			<td style="width:296px;">CR, Double-Crane, Beijing, China</td>
			<td style="width:113px;">H11020865</td>
			<td style="width:159px;">50 ml</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:205px;">Parenteral nutrition(Insulin injection)</td>
			<td style="width:296px;">No.1 biochemical and pharmaceutical, Shanghai, China</td>
			<td style="width:113px;">H31020519</td>
			<td style="width:159px;">28 Unit</td>
		</tr>
	</tbody>
</table>

application of end-to-end anastomosis in robotic central pancreatectomy

中心胰腺进行治疗的良性或低恶性潜在肿瘤位于胰腺颈部或近端的胰腺体。随着技术的发展, 机器人手术系统在微创手术中显示出了优势, 并越来越多地应用于中心胰腺。然而, 在机器人中心胰腺后, 用端到端吻合术重建胰腺的连续性尚未得到应用。在本研究中, 我们报告的手术技术的机器人中心胰腺与端到端吻合。胰管经导管与导管吻合术重建胰腺, 胰管置入胰管内两树桩, 胰实质端到端吻合。与传统的中央胰腺 pancreaticoenteric 吻合术相比, 该方法降低了患者的手术损伤, 同时也能有效的维持消化道和胰管的完整性和连续性。机器人手术系统结合多器械灵活、精确的运动, 特别适用于胰管的解剖和重建。我们发现, 机器人中心胰腺端到端吻合是安全可行的, 我们需要更多的经验来评估其最佳适应症和远期结果。

操作过程顺利。手术时间为141分钟, 术中失血约50毫升。切除的胰腺的大小约为 5.5 x 2.5 x 2.5 厘米 (图 4)。病人在手术后顺利康复, 并于 6th术后出院。当病人出院时, 他有正常的饮食和正常的排便, 没有发烧, 没有腹痛或腹胀。常规血液检查和血液生化检查无明显异常。Postopertative CT 扫描显示胰腺周围有轻微渗出, 胰管没有扩张或狭窄 (<strong class=...

Watch this Scientific Journal Video about Application of End-to-end Anastomosis in Robotic Central Pancreatectomy at JoVE.com

Application of End-to-end Anastomosis in Robotic Central Pancreatectomy

端到端吻合技术在机器人中心胰腺中的应用

端到端吻合的机器人中心胰腺在胰腺颈部和胰腺体近端肿瘤中是可行的、安全的。介绍了该手术的手术技术。

Central pancreatectomy is carried out for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of ...

Research

JoVE Journal

Medicine

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

遥控磁导航导管定位准确，实时和心脏电生理消融程序

New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac ...

科研

医学

Murine Ileocolic Bowel Resection with Primary Anastomosis

鼠回结肠肠管切除原发性吻合

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

Robotic Ablation of Atrial Fibrillation

房颤消融机器人

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Vessel-sparing Excision and Primary Anastomosis

血管保留切除术与原发性吻合术

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short ...

Creation of Colonic Anastomosis in Mice

小鼠结肠吻合术的建立

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of ...

One-anastomosis Gastric Bypass (OAGB) in Rats

One-anastomosis Gastric Bypass OAGB in Rats

大鼠胃旁路 (oagb) 的一次吻合

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical ...

Blood Collection Through Subclavian Vein Puncture in Mice

小鼠锁骨下静脉穿刺采血

The mouse is the foremost mammalian model for studying human disease and human health. However, blood sample collection from mice is challenging in ...

DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens

分离性造形切除术标本标准化病理学评估的DIPLOMA方法

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignant cancers. A minority (20%) of PDACs are found in the pancreatic body and tail. ...

A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application

大鼠胡萝卜动脉压力控制段气球损伤与腹腔ventit 治疗应用

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the ...