Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique
Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique
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DOI：
10.1159/000527249
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发表时间：
2022-09-28
影响因子：
2.7
通讯作者：
Fujiwara, Toshiyoshi
中科院分区：
文献类型：
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作者：
Takagi, Kosei;Yoshida, Ryuichi;Fujiwara, Toshiyoshi
微创保脾远端胰腺切除术（SPDP）在技术上具有挑战性，只有少数报告描述了微创SPDP的手术方法。本报告展示了我们在机器人SPDP中采用的新型胃肝韧带入路，保留了脾血管（Kimura技术中的上级窗口入路）。我们的机器人SPDP的胃肝韧带入路包括四个步骤。首先，广泛分离胃肝韧带，并确认胰腺（步骤1）。在这一步中，我们没有提起胃，也没有分开胃结肠韧带。接下来，解剖胰腺的上级和下级边界，并在上级肠系膜静脉上进行胰腺隧道术（步骤2）。胰腺分割（第3步）后，从内侧到外侧解剖胰体和胰尾，保留脾血管（第4步）。使用这种方法，胰腺可以直接进入通过胃肝韧带路线和解剖没有分裂的胃结肠韧带或回缩的胃。目前用于机器人SPDP的方法保留了脾血管，便于以最小的剥离容易地进入胰腺，并且在选定的患者中可以是可选的，包括具有低体重指数的患者。
Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.