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International Journal of Surgery... Sep 2023Augmented reality (AR)-assisted navigation system are currently good techniques for hepatectomy; however, its application and efficacy for laparoscopic...
Augmented reality-assisted navigation system contributes to better intraoperative and short-time outcomes of laparoscopic pancreaticoduodenectomy: a retrospective cohort study.
BACKGROUND
Augmented reality (AR)-assisted navigation system are currently good techniques for hepatectomy; however, its application and efficacy for laparoscopic pancreatoduodenectomy have not been reported. This study sought to focus on and evaluate the advantages of laparoscopic pancreatoduodenectomy guided by the AR-assisted navigation system in intraoperative and short-time outcomes.
METHODS
Eighty-two patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to May 2022 were enrolled and divided into the AR and non-AR groups. Clinical baseline features, operation time, intraoperative blood loss, blood transfusion rate, perioperative complications, and mortality were analyzed.
RESULTS
AR-guided laparoscopic pancreaticoduodenectomy was performed in the AR group ( n =41), whereas laparoscopic pancreatoduodenectomy was carried out routinely in the non-AR group ( n =41). There was no significant difference in baseline data between the two groups ( P >0.05); Although the operation time of the AR group was longer than that of the non-AR group (420.15±94.38 vs. 348.98±76.15, P <0.001), the AR group had a less intraoperative blood loss (219.51±167.03 vs. 312.20±195.51, P =0.023), lower blood transfusion rate (24.4 vs. 65.9%, P <0.001), lower occurrence rates of postoperative pancreatic fistula (12.2 vs. 46.3%, P =0.002) and bile leakage (0 vs. 14.6%, P =0.026), and shorter postoperative hospital stay (11.29±2.78 vs. 20.04±11.22, P <0.001) compared with the non-AR group.
CONCLUSION
AR-guided laparoscopic pancreatoduodenectomy has significant advantages in identifying important vascular structures, minimizing intraoperative damage, and reducing postoperative complications, suggesting that it is a safe, feasible method with a bright future in the clinical setting.
Topics: Humans; Pancreaticoduodenectomy; Retrospective Studies; Augmented Reality; Blood Loss, Surgical; Laparoscopy; Postoperative Complications; Treatment Outcome
PubMed: 37338535
DOI: 10.1097/JS9.0000000000000536 -
World Journal of Surgical Oncology Jan 2019Reoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early...
BACKGROUND
Reoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early reoperation following PD and analyze its effect on short- and long-term outcome.
METHODS
Four hundred and thirty-three patients that underwent PD between August 2006 and June 2016 were retrospectively analyzed.
RESULTS
Forty-eight patients (11%; ROp group) underwent 60 reoperations within 60 days from PD. Forty-two patients underwent 1 reoperation, and 6 had up to 6 reoperations. The average time to first reoperation was 10.1 ± 13.4 days. The most common indications were anastomotic leaks (22 operations in 18 patients; 37.5% of ROp), followed by post-pancreatectomy hemorrhage (PPH) (14 reoperations in 12 patients; 25%), and wound complications in 10 (20.8%). Patients with cholangiocarcinoma had the highest reoperation rate (25%) followed by ductal adenocarcinoma (12.3%). Reoperation was associated with increased length of hospital stay and a high post-operative mortality of 18.7%, compared to 2.6% for the non-reoperated group. For those who survived the post-operative period, the overall and disease-free survival were not affected by reoperation.
CONCLUSIONS
Early reoperations following PD carries a dramatically increased mortality rate, but has no impact on long-term survival.
Topics: Aged; Anastomotic Leak; Bile Duct Neoplasms; Carcinoma, Pancreatic Ductal; Cholangiocarcinoma; Female; Humans; Male; Middle Aged; Morbidity; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Reoperation; Retrospective Studies
PubMed: 30704497
DOI: 10.1186/s12957-019-1569-9 -
Medical Science Monitor : International... Apr 2018BACKGROUND Robotic assisted pancreaticoduodenectomy (RPD) is reported to be safe and feasible. Internal hernia (IH) after RPD is a serious but rarely reported...
BACKGROUND Robotic assisted pancreaticoduodenectomy (RPD) is reported to be safe and feasible. Internal hernia (IH) after RPD is a serious but rarely reported complication. MATERIAL AND METHODS We retrospectively reviewed data of 231 patients who underwent RPD from October 2010 to December 2016. The incidence, symptoms, time of presentation, and outcome were investigated. RESULTS Five patients (2.6%) were diagnosed with IH. Significant correlation (P<0.001) between IH and transverse mesocolon defect was confirmed. In patients without defect closure, the incidence of IH was 62.5%, while patients who received defect closure experienced no IH. The median time between initial surgery and occurrence of IH was 76 days. The main symptoms were abdominal pain, nausea, and vomiting. All patients received abdominal computed tomography (CT) and were suspected to have IH according to imaging and symptoms. All patients underwent reoperation (2 laparoscopic and 3 open surgery). The median length of hospital stay was 13 days. No patient experienced a relapse after treatment. CONCLUSIONS Abdominal pain, nausea, and vomiting were common symptoms in our study patients who underwent RPD. IH should be suspected if there is a positive finding on CT. Timely reoperation is necaAbdominal pain, nausea, and vomiting were common symptoms in our study patients who underwent RPD. IH should be suspected if there is a positive finding on CT. Timely reoperation is necessary because IH may cause intestinal ischemia. Meticulous closure of the mesenteric defect is vital to avoid IH.essary because IH may cause intestinal ischemia. Meticulous closure of the mesenteric defect is vital to avoid IH.
Topics: Abdominal Pain; Adult; Anastomosis, Surgical; Female; Hernia, Abdominal; Humans; Incidence; Laparoscopy; Male; Middle Aged; Pancreas; Pancreatectomy; Pancreaticoduodenectomy; Postoperative Complications; Reoperation; Retrospective Studies; Robotic Surgical Procedures; Tomography, X-Ray Computed
PubMed: 29658495
DOI: 10.12659/msm.909273 -
Digestive Surgery 2013Several studies suggested that pancreatic stents had some benefit during pancreatoduodenectomy (PD), but others disagree. Whether pancreatic duct stents could prevent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Several studies suggested that pancreatic stents had some benefit during pancreatoduodenectomy (PD), but others disagree. Whether pancreatic duct stents could prevent postoperative pancreatic fistula (POPF) is still under controversy.
METHODS
Randomized controlled trials published before November 2012 were all aggregated, focusing on the evaluation of pancreatic duct stents during PD. Trial data was reviewed and extracted independently by two reviewers. The quality of the including studies was assessed by the Cochrane handbook 5.1.0.
RESULTS
Seven studies were included, with a total of 793 patients. The results showed that compared with nonstents, stents during PD was associated with a significant difference on overall POPF rate (OR = 0.65, 95% CI 0.45-0.95, p = 0.02), POPF grades B and C (OR = 0.45, 95% CI 0.27-0.76, p = 0.003), and hospital stay (MD = -4.28, 95% CI -6.81, -1.75, p = 0.0009). Subgroup analyses showed that the external stent had a significant difference in the incidence of overall POPF (OR = 0.46, 95% CI 0.29-0.73, p = 0.0009), POPF grades B and C (OR = 0.49, 95% CI 0.30-0.79, p = 0.003), postoperative morbidity (OR = 0.63, 95% CI 0.42-0.96, p = 0.03), as well as hospital stay.
CONCLUSIONS
Based upon this meta-analysis, there might be potential benefit in reducing POPF thanks to the use of pancreatic duct stents.
Topics: Anastomosis, Surgical; Humans; Length of Stay; Pancreatic Ducts; Pancreaticoduodenectomy; Research Design; Stents; Survival Analysis; Treatment Outcome
PubMed: 24217416
DOI: 10.1159/000355982 -
Asian Journal of Surgery Apr 2020There are no reports available on patient satisfaction and quality-of-life after robotic pancreaticoduodenectomy (RPD). This study aimed to evaluate not only surgical...
BACKGROUND/OBJECTIVE
There are no reports available on patient satisfaction and quality-of-life after robotic pancreaticoduodenectomy (RPD). This study aimed to evaluate not only surgical outcomes but also patient satisfaction after RPD.
METHODS
Prospectively collected data for RPD were analyzed for surgical outcomes. Questionnaires were sent to patients to assess patient satisfaction regarding RPD.
RESULTS
The study included 105 patients who underwent RPD, with 44 (41.9%) patients presenting with associated surgical complications. There were no significant differences between the without and with complication groups in median console time (390 min. Vs. 373 min.), blood loss (100 mL vs. 100 mL), and harvested lymph node number (14 vs. 15). There was no surgical mortality in this study. Major complications ≥ Clavien-Dindo III occurred in 7.6% of the total 105 RPD patients. The most common complication was chyle leakage (18.1%), followed by postoperative pancreatic fistula (5.7%), intra-abdominal abscess (4.8%), delayed gastric emptying (3.8%), and post pancreatectomy hemorrhage (3.8%). Almost all of the patients responded to this RPD-related survey with "fair" to "excellent" grades for all items, except 1 (<1%) poor grade for operation service and 2 (1.9%) "not good" grades for diet tolerance.
CONCLUSIONS
RPD is a feasible procedure with acceptable surgical outcomes. This patient survey with high patient satisfaction rates indicates that RPD provides acceptable satisfaction results, and the robotic approach for a major operation such as RPD has probably a higher priority than cost concerns. RPD could be recommended not only to surgeons but also to patients in terms of surgical outcomes and patient satisfaction.
Topics: Adult; Aged; Aged, 80 and over; Anastomotic Leak; Chyle; Feasibility Studies; Female; Humans; Male; Middle Aged; Pancreatic Fistula; Pancreaticoduodenectomy; Patient Outcome Assessment; Patient Satisfaction; Postoperative Complications; Quality of Life; Robotic Surgical Procedures; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 31606357
DOI: 10.1016/j.asjsur.2019.08.012 -
HPB : the Official Journal of the... Jan 2015Enhanced recovery after surgery (ERAS) protocols have been shown to reduce hospital stay without compromising outcomes. Attempts to apply ERAS principles in the context... (Review)
Review
BACKGROUND
Enhanced recovery after surgery (ERAS) protocols have been shown to reduce hospital stay without compromising outcomes. Attempts to apply ERAS principles in the context of pancreatic surgery have generated encouraging results. A systematic review of the current evidence for ERAS following pancreatic surgery was conducted.
METHODS
A literature search of MEDLINE, CINAHL, EMBASE and the Cochrane Library was performed for articles describing postoperative clinical pathways in pancreatic surgery during the years 2000-2013. The keywords 'clinical pathway', 'critical pathway', 'fast-track', 'pancreas' and 'surgery' and their synonyms were used as search terms. Articles were selected for inclusion based on predefined criteria and ranked for quality. Details of the ERAS protocols and relevant outcomes were extracted and analysed.
RESULTS
Ten articles describing an ERAS protocol in pancreatic surgery were identified. The level of evidence was graded as low to moderate. No articles reported an adverse effect of an ERAS protocol for pancreatic surgery on perioperative morbidity or mortality. Length of stay (LoS) was decreased and readmission rates were found to be unchanged in six of seven studies that compared these outcomes.
CONCLUSIONS
Evidence indicates that ERAS protocols may be implemented in pancreatic surgery without compromising patient safety or increasing LoS. Enhanced recovery after surgery programmes in the context of pancreatic surgery should be standardized based upon the best available evidence, and trials of ERAS programmes involving multiple centres should be performed.
Topics: Humans; Length of Stay; Pancreatectomy; Pancreatic Diseases; Pancreaticoduodenectomy; Postoperative Complications; Recovery of Function; Time Factors; Treatment Outcome
PubMed: 24750457
DOI: 10.1111/hpb.12265 -
Journal of Visualized Experiments : JoVE Jun 2018Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal pancreatectomy, laparoscopic...
Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal pancreatectomy, laparoscopic pancreatoduodenectomy (LPD) has not yet obtained wide acceptance, probably due to technical challenges, especially regarding the pancreatic anastomosis. The study describes and demonstrates all steps of LPD, including the modified Blumgart pancreaticojejunostomy. Indications for LPD are all pancreatic and peri-ampullary tumors without vascular involvement. Relative contra-indications are body mass index >35 kg/m, chronic pancreatitis, mid-cholangiocarcinomas and large duodenal cancers. The patient is in French position, 6 trocars are placed, and dissection is performed using an (articulating) sealing device. A modified Blumgart end-to-side pancreaticojejunostomy is performed with 4 large needles (3/0) barbed trans-pancreatic sutures and 4 to 6 duct-to-mucosa sutures using 5/0 absorbable multifilament combined with a 12 cm, 6 or 8 Fr internal stent using 3D laparoscopy. Two surgical drains are placed alongside the pancreaticojejunostomy. The described technique for LPD including a modified Blumgart pancreatico-jejunostomy is well standardized, and its merits are currently studied in the randomized controlled multicenter trial. This complex operation should be performed at high-volume centers where surgeons have extensive experience in both open pancreatic surgery and advanced laparoscopic gastro-intestinal surgery.
Topics: Anastomosis, Surgical; Female; Humans; Laparoscopy; Male; Pancreaticoduodenectomy; Pancreaticojejunostomy
PubMed: 29985364
DOI: 10.3791/56819 -
JAMA Surgery May 2020Robot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of...
IMPORTANCE
Robot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of minimally invasive pancreatic surgery such as laparoscopic pancreaticoduodenectomy. To our knowledge, no reports exist on the outcomes of open pancreaticoduodenectomy (OPD) and RPD after the learning curve.
OBJECTIVE
To analyze and evaluate the actual advantages of RPD.
DESIGN, SETTING, AND PARTICIPANTS
Between May 2010 and December 2018, 450 patients underwent RPD in the Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University in Shanghai, China, a high-volume pancreatic disease center. According to our previous study, an important flexion point in the learning curve is 250 cases. Data on the last 200 RPD cases were collected from January 2017 to December 2018. During that period, 634 patients underwent OPD. These patients were divided into 2 groups, and propensity score matching was used to minimize bias. The demographic data and operative outcomes were collected and analyzed. Analysis began May 2019.
EXPOSURES
Robot-assisted pancreaticoduodenectomy and OPD.
MAIN OUTCOMES AND MEASURES
The short-term operative outcomes of RPD and OPD.
RESULTS
After 1:1 matching, 187 cases of RPD and OPD were recorded. In the RPD group, 78 patients (41.7%) were women, and the mean (SD) age was 60.9 (11.4) years. In the OPD group, 80 patients (42.8%) were women, and the mean (SD) age was 60.1 (10.8) years. Robot-assisted pancreaticoduodenectomy had advantages in operative time (mean [SD], 279.7 [76.3] minutes vs 298.2 [78.3] minutes; P = .02), estimated blood loss (mean [SD], 297.3 [246.8] mL vs 415.2 [497.9] mL; P = .002), and postoperative length of hospital stay (mean [SD], 22.4 [16.7] days vs 26.1 [16.3] days; P = .03). However, there was no significant difference in the R0 resection rate and incidence rate of postoperative complications, such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. The incidence rates of postoperative bleeding and reoperation in the RPD group were similar to those in the OPD group, with no statistically significant difference.
CONCLUSIONS AND RELEVANCE
After passing the learning curve, RPD had advantages in operative time and blood loss compared with OPD. There were no differences in postoperative complications such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. However, patients recovered more quickly after RPD than after OPD. A prospective randomized clinical trial is needed in the future to verify these results.
Topics: Aged; Female; Humans; Learning Curve; Male; Middle Aged; Pancreatic Diseases; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Time Factors; Treatment Outcome
PubMed: 32129815
DOI: 10.1001/jamasurg.2020.0021 -
International Journal of Surgery... Sep 2020Robotic pancreaticoduodenectomy (RPD) has gradually been accepted as it has overcome some of the limitations of laparoscopic surgery. Outcomes following RPD in elderly...
BACKGROUND
Robotic pancreaticoduodenectomy (RPD) has gradually been accepted as it has overcome some of the limitations of laparoscopic surgery. Outcomes following RPD in elderly patients are still uncertain. This study aimed to evaluate the safety and feasibility of RPD in elderly patients.
METHODS
The demographics and perioperative outcomes of a consecutive series of patients who underwent RPD between January 2018 and September 2019, were retrospectively analyzed. Patients were divided into 2 groups: elderly patients (≥75 years) and younger patients (<75 years).
RESULTS
Of 431 patients who were included in this study, 77 were elderly patients and 354 were younger patients. Elderly patients had a significantly higher ASA score than younger patients (P < 0.001). There were no significant differences in operative time, estimated blood loss and blood transfusion rate between groups (P > 0.05). Elderly patients had significantly higher morbidity and longer postoperative hospital stay than younger patients (49.3% vs. 31.1%, P = 0.002; 22.8 vs. 13.3 days, P < 0.001, respectively). However, the reoperation, 90-day readmission and mortality rates were comparable in the two groups (P > 0.05). Multivariate analysis demonstrated that a higher ASA score was the only independent factor for postoperative morbidity (OR 2.02, 95% CI 1.06-3.88, P = 0.03), while old age was not (OR 0.81, 95% CI 0.36-1.81, P = 0.80).
CONCLUSION
This study demonstrated that RDP was safe and feasible in elderly patients. Age should not be a contraindication to RPD. Elderly patients with careful patient selection should be considered for RPD.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Operative Time; Pancreaticoduodenectomy; Reoperation; Retrospective Studies; Robotic Surgical Procedures
PubMed: 32750491
DOI: 10.1016/j.ijsu.2020.07.049 -
Journal of Nippon Medical School =... 2011Chronic pancreatitis (CP) is a painful, yet benign inflammatory process of the pancreas. Surgical management should be individualized because the pain is multifactorial... (Review)
Review
Chronic pancreatitis (CP) is a painful, yet benign inflammatory process of the pancreas. Surgical management should be individualized because the pain is multifactorial and its mechanisms vary from patient to patient. Two main pathogenetic theories for the mechanisms of pain in CP have been proposed: the neurogenic theory and the theory of increased intraductal/intraparenchymal pressures. The latter theory is strongly supported by the good results of drainage procedures in the surgical management of CP. Other possible contributing factors include pancreatic ischemia; a centrally sensitized pain state; and the development of complications, such as pseudocysts and stenosis of the duodenum or common bile duct. Common indications for surgery include intractable pain, suspicion of neoplasm, and complications that cannot be resolved with radiological or endoscopic treatments. Operative procedures have been historically classified into 4 categories: decompression procedures for diseased and obstructed pancreatic ducts; resection procedures for the proximal, distal, or total pancreas; denervation procedures of the pancreas; and hybrid procedures. Pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy, once the standard operations for patients with CP, have been replaced by hybrid procedures, such as duodenum-preserving pancreatic head resection, the Frey procedure, and their variants. These procedures are safe and effective in providing long-term pain relief and in treating CP-related complications. Hybrid procedures should be the operations of choice for patients with CP.
Topics: Humans; Pancreaticoduodenectomy; Pancreatitis, Chronic
PubMed: 22197867
DOI: 10.1272/jnms.78.352