Name: laparoscopic radical left pancreatectomy for pancreatic cancer: surgical strategy and technique video
Uploaded: 2020-06-06T12:30:00
Description: Watch this Scientific Journal Video about Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video at JoVE.com

这种技术最初是由阿布·希拉勒等人16日描述的。

1. 患者选择
<ol><li>选择胰腺体或尾部有前期可排位胰腺癌的患者，在近期对比增强的CT扫描（最多4周大）上可见，无需下例新发治疗。</li>
	<li>不包括转移性疾病或血管参与的血管参与，但除增静脉或动脉24外。</li>
	<li>在训练期间，最好排除身体最大指数 （BMI） > 35 kg/m2、复发性急性或慢性胰腺炎、以前的大腹部手术或胰腺靶向放射治疗的患者。</li>
</ol><p class="jove_titl...

<ol>
	<li>Sui, C. 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=Laparoscopic+versus+open+distal+pancreatectomy:+a+meta-analysis.">Laparoscopic versus open distal pancreatectomy: a meta-analysis.</a> Asian Journal of Surgery. 35, 1-8 (2012).</li><li>Venkat, 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=Laparoscopic+distal+pancreatectomy+is+associated+with+significantly+less+overall+morbidity+compared+to+the+open+technique:+A+systematic+review+and+meta-analysis.">Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: A systematic review and meta-analysis.</a> Annals of Surgery. 255, 1048-1059 (2012).</li><li>Pericleous, 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=Systematic+review+and+meta-analysis+of+case-matched+studies+comparing+open+and+laparoscopic+distal+pancreatectomy:+is+it+a+safe+procedure.">Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure.</a> Pancreas. 41, 993-1000 (2012).</li><li>Jin, 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=A+systematic+review+and+meta-analysis+of+studies+comparing+laparoscopic+and+open+distal+pancreatectomy.">A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy.</a> HPB. 14, 711-724 (2012).</li><li>Jusoh, A. C., Ammori, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+versus+open+distal+pancreatectomy:+a+systematic+review+of+comparative+studies.">Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies.</a> Surgical Endoscopy. 26, 904-913 (2012).</li><li>Xie, K., 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=Laparoscopic+distal+pancreatectomy+is+as+safe+and+feasible+as+open+procedure:+A+meta-analysis.">Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: A meta-analysis.</a> World Journal of Gastroenterology. 18, 1959-1967 (2012).</li><li>De Rooij, 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=Minimally+Invasive+Versus+Open+Distal+Pancreatectomy+(LEOPARD):+A+Multicenter+Patient-blinded+Randomized+Controlled+Trial.">Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial.</a> Annals of Surgery. 269, 2-9 (2019).</li><li>Kim, S. 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=Comparative+analysis+of+clinical+outcomes+for+laparoscopic+distal+pancreatic+resection+and+open+distal+pancreatic+resection+at+a+single+institution.">Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution.</a> Surgical Endoscopy. 22, 2261-2268 (2008).</li><li>Mehta, S. 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=Laparoscopic+versus+open+distal+pancreatectomy:+A+single-institution+case-control+study.">Laparoscopic versus open distal pancreatectomy: A single-institution case-control study.</a> Surgical Endoscopy. 26, 402-407 (2012).</li><li>Melotti, G., 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=Laparoscopic+distal+pancreatectomy:+Results+on+a+consecutive+series+of+58+patients.">Laparoscopic distal pancreatectomy: Results on a consecutive series of 58 patients.</a> Annals of Surgery. 246, 77-82 (2007).</li><li>Abu Hilal, 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=Laparoscopic+versus+open+distal+pancreatectomy:+A+clinical+and+cost-effectiveness+study.">Laparoscopic versus open distal pancreatectomy: A clinical and cost-effectiveness study.</a> Surgical Endoscopy. 26, 1670-1674 (2012).</li><li>Richardson, 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=Implementation+of+enhanced+recovery+programme+for+laparoscopic+distal+pancreatectomy:+Feasibility,+safety+and+cost+analysis.">Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: Feasibility, safety and cost analysis.</a> Pancreatology. 15, 185-190 (2015).</li><li>Abu Hilal, 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=Laparoscopic+distal+pancreatectomy:+Critical+analysis+of+preliminary+experience+from+a+tertiary+referral+centre.">Laparoscopic distal pancreatectomy: Critical analysis of preliminary experience from a tertiary referral centre.</a> Surgical Endoscopy. 23, 2743-2747 (2009).</li><li>van Hilst, 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=Minimally+Invasive+versus+Open+Distal+Pancreatectomy+for+Ductal+Adenocarcinoma+(DIPLOMA):+A+Pan-European+Propensity+Score+Matched+Study.">Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study.</a> Annals of Surgery. 269, 10-17 (2019).</li><li>Strasberg, S. M., Drebin, J. A., Linehan, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radical+antegrade+modular+pancreatosplenectomy.">Radical antegrade modular pancreatosplenectomy.</a> Surgery. 133, 521-527 (2003).</li><li>Abu Hilal, 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=Laparoscopic+radical+'no-touch'+left+pancreatosplenectomy+for+pancreatic+ductal+adenocarcinoma:+technique+and+results.">Laparoscopic radical 'no-touch' left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results.</a> Surgical Endoscopy. 30, 3830-3838 (2016).</li><li>Abu Hilal, M., Takhar, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+left+pancreatectomy:+Current+concepts.">Laparoscopic left pancreatectomy: Current concepts.</a> Pancreatology. 13, 443-448 (2013).</li><li>De Rooij, 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=Pan-European+survey+on+the+implementation+of+minimally+invasive+pancreatic+surgery+with+emphasis+on+cancer.">Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer.</a> HPB. 18, 170-176 (2016).</li><li>Van Hilst, 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=Worldwide+survey+on+opinions+and+use+of+minimally+invasive+pancreatic+resection.">Worldwide survey on opinions and use of minimally invasive pancreatic resection.</a> HPB. 19, 190-204 (2017).</li><li>Yang, D. 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=The+oncological+safety+in+minimally+invasive+versus+open+distal+pancreatectomy+for+pancreatic+ductal+adenocarcinoma:+a+systematic+review+and+meta-analysis.">The oncological safety in minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis.</a> Scientific Reports. 9, 1159 (2019).</li><li>Van Hilst, 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=Oncologic+outcomes+of+minimally+invasive+versus+open+distal+pancreatectomy+for+pancreatic+ductal+adenocarcinoma:+A+systematic+review+and+meta-analysis.">Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis.</a> European Journal of Surgical Oncology. 45, 719-727 (2018).</li><li>O'Morchoe, C. C. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+system+of+the+pancreas.">Lymphatic system of the pancreas.</a> Microscopy Research and Technique. 37, 456-477 (1997).</li><li>Van Hilst, 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=Distal+pancreatectomy,+minimally+invasive+or+open,+for+malignancy.">Distal pancreatectomy, minimally invasive or open, for malignancy.</a> ISRCTN Registry. , (2019).</li><li>Ducreux, 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=Cancer+of+the+pancreas:+ESMO+Clinical+Practice+Guidelines+for+diagnosis,+treatment+and+follow-up.">Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.</a> Annals of Oncology Official Journal of the European Society for Medical Oncology. 26, 56-68 (2015).</li><li>Dokmak, 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=Double+Gastric+Hanging+for+Gastric+Exposure+in+Laparoscopic+Distal+Pancreatectomy.">Double Gastric Hanging for Gastric Exposure in Laparoscopic Distal Pancreatectomy.</a> Digestive Surgery. , 1-6 (2019).</li><li>Asbun, H. J., Stauffer, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+approach+to+distal+and+subtotal+pancreatectomy:+A+clockwise+technique.">Laparoscopic approach to distal and subtotal pancreatectomy: A clockwise technique.</a> Surgical Endoscopy. 25, 2643-2649 (2011).</li><li>Kim, H., 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=Optimal+stapler+cartridge+selection+according+to+the+thickness+of+the+pancreas+in+distal+pancreatectomy.">Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy.</a> The American Journal of Medicine. 95, 0 (2016).</li><li>Hirota, 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=Pancreatoduodenectomy+using+a+no-touch+isolation+technique.">Pancreatoduodenectomy using a no-touch isolation technique.</a> The American Journal of Surgery. 199, 65-68 (2010).</li><li>Magge, D., 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=Comparative+effectiveness+of+minimally+invasive+and+open+distal+pancreatectomy+for+ductal+adenocarcinoma.">Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma.</a> JAMA Surgery. 148, 525-531 (2013).</li><li>Kooby, D. 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=Left-sided+pancreatectomy:+A+multicenter+comparison+of+laparoscopic+and+open+approaches.">Left-sided pancreatectomy: A multicenter comparison of laparoscopic and open approaches.</a> Annals of Surgery. 248, 438-446 (2008).</li><li>Stauffer, J. 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=Comparison+of+open+with+laparoscopic+distal+pancreatectomy:+A+single+institution's+transition+over+a+7-year+period.">Comparison of open with laparoscopic distal pancreatectomy: A single institution's transition over a 7-year period.</a> HPB. 15, 149-155 (2013).</li><li>Baker, M. S., Bentrem, D. J., Ujiki, M. B., Stocker, S., Talamonti, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+single+institution+comparison+of+peri-operative+outcomes+for+laparoscopic+and+open+distal+pancreatectomy.">A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy.</a> Surgery. 146, 635-643 (2009).</li><li>Jayaraman, 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=Laparoscopic+Distal+Pancreatectomy+Evolution+of+a+Technique+at+a+Single+Institution.">Laparoscopic Distal Pancreatectomy Evolution of a Technique at a Single Institution.</a> ACS. 211, 503-509 (2010).</li><li>van Rijssen, L. 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=Variation+in+hospital+mortality+after+pancreatoduodenectomy+is+related+to+failure+to+rescue+rather+than+major+complications:+a+nationwide+audit.">Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit.</a> HPB. 20, 759-767 (2018).</li><li>de Rooij, T., Sitarz, R., Busch, O. R., Besselink, M. G., Abu Hilal, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technical+Aspects+of+Laparoscopic+Distal+Pancreatectomy+for+Benign+and+Malignant+Disease:+Review+of+the+Literature.">Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature.</a> Gastroenterology of Research and Practice. 2015, 472906 (2015).</li></ol>

该技术的优点 LRLP 是一个标准化、可重复和安全的程序，如果由经验丰富的外科医生执行。此外，这种微创手术提供低术中失血，早期动员，和短期住院，这得到LEOPARD试验7所证实。胰腺癌手术必须着眼于彻底切除，适当的淋巴切除术，和无接触解剖，以防止肿瘤细胞的种子和传播16，28。16,Laparoscopy可以提供高质量的可?...

手术切除与全身化疗相结合，是治疗可切除胰腺癌的最有效办法。几个元分析显示，良性和恶性疾病11，2，3，4，5，62,3,4,5,6的微创和开放远端造体切除术的可比结果。最近，第一个多中心随机试验显示，与开放远端造影（ODP）7相比，使用腹腔镜远端造影切除术（LDP）的功能恢复时间较短。7虽然微创技术在经验丰富的外科医生16,1715,,148、9、10、11、12、139,进行时，对8左造血术是安全和可行的，但与治疗胰腺癌的开放手术方法相比，微创手术的非自卑性仍有待讨论。10,11,12,13泛欧调查显示，31%的胰腺外科医生认为ODP优于微创直肠造样切除术（MIDP），在胰腺癌的肿瘤边缘和淋巴切除术方面。在欧洲和全球层面，19-20%的参与外科医生认为恶性肿瘤是微创方法18、19,19的禁忌。
鉴于目前缺乏关于MIDP有效性的随机对照试验，唯一可用于比较这些程序的现有数据仅限于回顾性和前瞻性队列研究。在最近关于胰腺癌MIDP与ODP肿瘤安全性的系统回顾和荟萃分析中，两组在肿瘤结果（OR = 0.49，p = 0.12）和整体存活率（OS = 3 年，HR = 1.03，p = 0.66）方面没有差异; p pOS = 5 年，HR = p 0.91，p = 0.59）被看到20。另一项系统综述显示MIDP与ODP在整体存活率方面可有可比结果，利润率为负（R0）切除率略高，但以MIDP21中淋巴结切除较低为代价。
正如Strasberg在2003年描述的那样，激进的前科模块化胰腺切除术（RAMPS）技术旨在对胰腺导管腺癌（PDAC）进行更好的、激进的切除，包括切除Gerota的筋膜15。腹腔镜基左造影切除术（LRLP）技术，如Abu Hilal等人16所述，旨在通过结合正式淋巴腺切除术和无接触技术，获得相同的结果，但在微创手术期间。因此，可以获得一个激进的肿瘤切除，尽量减少肿瘤传播和播种的风险15，22。15,该技术的标准化允许在不同的卫生保健中心进行重复和采用。本文介绍了LRLP，因为该技术目前用于国际多中心随机的DIPLOMA试验16、23。16,

<table>
	<tbody>
		<tr>
			<td>Arietta Ultrasound</td>
			<td>Hitachi</td>
			<td></td>
			<td>Intraoperative laparoscopic ultrasonography</td>
		</tr>
		<tr>
			<td>Autosuture Endo Clip applier 5 mm</td>
			<td>Covidien</td>
			<td>176620</td>
			<td>Sling use clip applier, 5 mm</td>
		</tr>
		<tr>
			<td>Blue reload for Echelon 60</td>
			<td>Ethicon</td>
			<td>GST60B</td>
			<td>Regular tissue thickness, open staple height 3.6 mm, closed staple height 1.5 mm</td>
		</tr>
		<tr>
			<td>ECHELON FLEX ENDOPATH 60mm Stapler</td>
			<td>Ethicon</td>
			<td>GST60T</td>
			<td>Powered surgical stapler with gripping surface technology</td>
		</tr>
		<tr>
			<td>Endo Catch II Pouch 15 mm</td>
			<td>Covidien</td>
			<td>173049</td>
			<td>For single lymph node extractions a cut off finger surgical glove can be used.</td>
		</tr>
		<tr>
			<td>Green reload for Echelon 60</td>
			<td>Ethicon</td>
			<td>GST60G</td>
			<td>Thick tissue thickness, open staple height 4.1 mm, closed staple height 2.0 mm</td>
		</tr>
		<tr>
			<td>Harmonic Advanced Hemostasis 36 cm</td>
			<td>Ethicon</td>
			<td>HARH36</td>
			<td>Curved tip, energy sealing and dissecting, diameter 5 mm, length 36 cm</td>
		</tr>
		<tr>
			<td>Hem-o-lok Clips MLX</td>
			<td>Weck Surgical Instruments, Teleflex Medical, Durham, NC</td>
			<td>544230</td>
			<td>Vascular clip 3 mm &#8211; 10 mm Size Range</td>
		</tr>
		<tr>
			<td>Hem-o-lok clips Xl</td>
			<td>Weck Surgical Instruments, Teleflex Medical, Durham, NC</td>
			<td>544250</td>
			<td>Vascular clip 7 mm &#8211; 16 mm Size Range</td>
		</tr>
		<tr>
			<td>Hem-o-Lok Polymer Ligation System</td>
			<td>Weck Surgical Instruments, Teleflex Medical, Durham, NC</td>
			<td>544965</td>
			<td></td>
		</tr>
		<tr>
			<td>LigaSure Dolphin Tip Laparoscopic Sealer/Divider</td>
			<td>Medtronic</td>
			<td>LS1500</td>
			<td>Dolphin-nose tip sealer and divider, 37 cm shaft</td>
		</tr>
		<tr>
			<td>White reload for Echelon 60</td>
			<td>Ethicon</td>
			<td>GST60W</td>
			<td>Mesentery/thin tissue thickness, open staple height 2.6 mm, closed staple height 1.0 mm</td>
		</tr>
	</tbody>
</table>

laparoscopic radical left pancreatectomy for pancreatic cancer: surgical strategy and technique video

根切除边缘、切除Gerota（肾外腺）筋膜和足够的淋巴结解剖对于对左侧胰腺癌进行充分的肿瘤切除至关重要。近年来，人们描述了几种外科技术，但很少有手术技术是专门为微创方法设计的。这项研究描述并演示了一种标准化和可重复的技术，用于胰腺癌的肿瘤切除：腹腔镜基左造影术（LRLP）。
一名61岁的妇女偶然发现左胰腺中一个3厘米质量的恶性肿瘤嫌疑人。成像没有显示遥远的转移，中枢血管参与，或病态肥胖，因此患者适合LRLP。本研究描述了LRLP治疗胰腺癌的主要步骤。首先，较小的囊通过横断肠韧带打开。结肠的脾脏弯曲被动员起来，胰腺的劣质边界，包括杰罗塔的筋膜被解剖到脾脏的劣为边界。胰腺是隧道和悬挂，包括Gerota的筋膜与船环。在胰腺颈部，胰腺和入口静脉之间形成一条隧道，同样通过血管回路。然后，使用内皮板的分级压缩技术将胰腺进行转断。在完成切除之前，体膜静脉和动脉均被横断体。整个标本通过小普法南斯蒂尔切口在检索袋中提取。
手术持续时间为210分钟，失血250mL。病理学揭示了一个R0切除（>1毫米）的一个良好到中度分化的腺癌，起源于一个内电导的皮毛体粘结肿瘤。共有15个肿瘤阴性淋巴结被切除。这是左侧胰腺癌LRLP的详细描述，目前在国际多中心随机科文图（离心造微菌微创或PDAC开放）试验中使用。

一名61岁的妇女在外科门诊部出现轻度肝功能障碍。在CT和MRI扫描中，在胰腺尾部疑似恶性肿瘤的3厘米质量的偶然发现被发现与左肾上腺的潜在参与（见图2）。在术前对比增强CT扫描中，没有发现遥远的转移或淋巴结参与。因此，患者被认为适合微创方法。
总手术时间是210分钟，失血250mL。术中肾上腺未参与，LRLP被执行，使肾上腺留在原位。术后课程并...

Watch this Scientific Journal Video about Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video at JoVE.com

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

肿瘤学上安全的左造体切除术需要彻底切除（R0）、Gerota的（肾外）筋膜切除和适当的淋巴结解剖。本研究描述了腹腔镜基左造影切除术（LRLP）的技术细节，该试验用于第一个国际多中心随机试验，比较胰腺癌的微创性与左开胰腺切除术，DIPLOMA试验。

胰腺癌的腹腔镜根左造影切除术：手术策略与技术视频

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

腹腔镜基左胰腺切除术恶性肿瘤。充足的淋巴结解剖和激进的切除边缘对于在重心胰腺切除术中获得肿瘤的安全肿瘤解剖至关重要。我们演示了腹腔镜基左胰腺切除术的所有步骤，如阿布·希拉尔等人所述。一名61岁的妇女偶然发现胰腺尾部有一个三厘米的质量，怀疑是恶性肿瘤。术前CT扫描中不存在远距离转移，也没有淋巴结介入。患者适合微创方法。手术步骤包括小车放置、五个不同的手术阶段和小车场地的关闭。肺病是由左忧郁症中的 Veress 针创建的。首先，进行腹腔镜诊断，排除腹腔和肝脏转移。此后，附加的小车将如图所示放置。暴露阶段能够充分处理胰腺尾部和识别主要船只和飞机。打开胃侧韧带后，对短胃血管进行解剖和连接，以准备脾脏切除。胃从胰腺分离，并收回前。为此，在胃周围放置一个脐带，如胰腺前平面所述，现在暴露。这能够识别胰腺的劣质边界的静脉和与胰腺标本一起保留的杰罗塔筋膜切口。请记住，低劣的肠胃静脉可以插入到这个位置的静脉。因此，明智的做法是查阅此区域的成像。静脉动脉在胰腺的上边缘局部。下一步是胰腺绞刑和解剖杰罗塔的筋膜。首先，胰腺肌韧带和飞溅韧带可以转因。特别是，杰罗塔的筋膜可以转切，以暴露肾脏的前部。现在胰腺在横向位置被隧道。然后用悬挂技术解除。这包括格罗塔的筋膜，留在胰腺标本。血小和肝动脉被明确识别。静脉动脉要么用斗牛犬夹遮挡，要么使用 Hem-o-lok 夹子或订书机进行穿。应特别注意不要将肝动脉误认为是血动脉。现在有限的血流水减少解剖期间的失血。其次，在这个阶段，胰腺颈部被隧道和解除使用相同的悬挂技术。额外的后部暴露是在静脉前创建的。在此区域，将插入订书机。下一步是胰腺转节。订书机被轻轻地关闭，直到感觉到阻力。此时，外科医生应等待，直到阻力降低，然后再继续压缩。这种创造性的压缩技术，如描述需要四到五分钟，是至关重要的，以避免胰腺胶囊破裂。如果需要，可以将用于进一步闭合的缝合线应用于胰腺树桩。从这里，紧张的第一个点将是静脉的转越。抬起静脉后，它通过 Hem-o-lok 夹或血管订书机进行转切。下一个操作步骤是淋巴结解剖。小心和细致，动脉释放淋巴。淋巴切除术应扩展到主动脉的左边界和上肠动脉的左侧。左胃动脉应保留，同时进行淋巴切除围绕它。最后，解剖横向向脾脏进行，在那里进一步进行附着组织。应注意从胃肠韧带开始的脾脏解剖。脾脏与逆转性粘附分离。最后一个阶段是提取试样和排水位置。一旦释放，标本通过Pfannenstiel切口用内托袋去除。相机应向下转动 180 度到腹部的劣等部分。一旦手术排水管被放置，这个排水管进入最左侧的小车站点，并在 splenic fossa 的位置切割两个额外的侧孔，以便更好地排水。注意避免直接接触胰腺、动脉和静脉树桩。12 毫米端口的筋膜使用 Vicryl 缝合和皮肤皮内关闭。手术总持续时间为210分钟，估计失血250毫升。病理学揭示了一个良好到中度分化腺癌的R0切除。它起源于一种电内膜粘膜肿瘤。共有15个肿瘤阴性淋巴结被切除。这是一个详细的描述腹腔镜基左胰腺切除术癌症在C拉梅试验中执行。

Research

JoVE Journal

Medicine

Surgical Procedures for a Rat Model of Partial Orthotopic Liver Transplantation with Hepatic Arterial Reconstruction

部分原位肝移植大鼠模型的肝动脉重建的外科手术

Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as ...

科研

医学

Improved Protocol For Laser Microdissection Of Human Pancreatic Islets From Surgical Specimens

从手术标本的人类胰岛细胞激光显微切割的改进方法

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected ...

Bioluminescent Orthotopic Model of Pancreatic Cancer Progression

生物荧光原位模型胰腺癌进展

Pancreatic cancer has an extremely poor five-year survival rate of 4-6%.  New therapeutic options are critically needed and depend on improved ...

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

自愿屏气技术减少心脏剂量的左乳房放射治疗

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these ...

Studying Pancreatic Cancer Stem Cell Characteristics for Developing New Treatment Strategies

研究胰腺癌干细胞特性开发新的治疗策略

Pancreatic ductal adenocarcinoma (PDAC) contains a subset of exclusively tumorigenic cancer stem cells (CSCs) which have been shown to drive tumor ...

Laparoscopic Technique for Serial Collection of Liver and Mesenteric Lymph Nodes in Macaques

腹腔镜技术在猕猴肝和肠系膜淋巴结的串行采集

The mesenteric lymph nodes (MLN) and the liver are exposed to microbes and microbial products from the gastrointestinal (GI) tract, making them ...

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

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

Generating a Murine Orthotopic Metastatic Breast Cancer Model and Performing Murine Radical Mastectomy

小鼠原位转移性乳腺癌模型的建立及小鼠根治性乳房切除术

In vivo mouse models to assess breast cancer progression are essential for cancer research, including preclinical drug developments. However, the majority ...

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. ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

在卵巢子宫内膜异位症腹腔镜膀胱切除术期间优化卵巢储备的手术技术

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...