250 Robotic Pancreatic Resections Safety and Feasibility
250 Robotic Pancreatic Resections Safety and Feasibility
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DOI：
10.1097/sla.0b013e3182a4e87c
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发表时间：
2013-10-01
影响因子：
9
通讯作者：
Zeh, Herbert J., III
中科院分区：
文献类型：
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作者：
Zureikat, Amer H.;Moser, A. James;Zeh, Herbert J., III
背景和目标：计算机辅助机器人手术允许以与开放手术几乎相同的标准进行复杂的切除和吻合重建。我们将该技术应用于各种胰腺切除术，以评估该技术的安全性、可行性、多功能性和可靠性。方法：对2008年8月至2012年11月期间单个机构机器人胰腺切除术的前瞻性数据库进行回顾性审查。分析围手术期结果。 结果：分析了总共 250 例连续的机器人胰腺切除术；胰十二指肠切除术 (132)、远端胰腺切除术 (83)、中央胰腺切除术 (13)、胰腺剜除术 (10)、全胰腺切除术 (5)、Appleby 切除术 (4) 和 Frey 手术 (3)。 30 天和 90 天死亡率分别为 0.8% 和 2.0%。 Clavien 3和4并发症的发生率分别为14%和6%。国际胰瘘研究小组的C级瘘率为4%。两种最常见手术的平均手术时间（胰十二指肠切除术）为 529 +/- 103 分钟，远端胰腺切除术为 257 +/- 93 分钟。在整个体验过程中观察到手术时间持续改善。 16 名患者 (6%)（11 名接受胰十二指肠切除术，2 名接受远端胰腺切除术，2 名接受中央胰腺切除术，1 名接受全胰腺切除术）因进展失败 (14 例) 和出血 (2 例) 需要转为开腹手术。 结论：据我们所知，这是最大的机器人胰腺切除系列。安全性和可行性指标（包括低转换率）支持该平台的稳健性，并且表明该新技术不存在不可预见的固有风险。通过定义这些早期结果指标，本报告开始建立该平台的比较有效性研究框架。
Background and Objectives: Computer-assisted robotic surgery allows complex resections and anastomotic reconstructions to be performed with nearly identical standards to open surgery. We applied this technology to a variety of pancreatic resections to assess the safety, feasibility, versatility, and reliability of this technology.Methods: A retrospective review of a prospective database of robotic pancreatic resections at a single institution between August 2008 and November 2012 was performed. Perioperative outcomes were analyzed.Results: A total of 250 consecutive robotic pancreatic resections were analyzed; pancreaticoduodenectomy (132), distal pancreatectomy (83), central pancreatectomy (13), pancreatic enucleation (10), total pancreatectomy (5), Appleby resection (4), and Frey procedure (3). Thirty-day and 90-day mortality was 0.8% and 2.0%. Rate of Clavien 3 and 4 complications was 14% and 6%. The International Study Group on Pancreatic Fistula grade C fistula rate was 4%. Mean operative time for the 2 most common procedures was 529 +/- 103 minutes for pancreaticoduodenectomy and 257 +/- 93 minutes for distal pancreatectomy. Continuous improvement in operative times was observed over the course of the experience. Conversion to open procedure was required in 16 patients (6%) (11 with pancreaticoduodenectomy, 2 with distal pancreatectomy, 2 with central pancreatectomy, 1 with total pancreatectomy) for failure to progress (14) and bleeding (2).Conclusions: This represents to our knowledge the largest series of robotic pancreatic resections. Safety and feasibility metrics including the low incidence of conversion support the robustness of this platform and suggest no unanticipated risks inherent to this new technology. By defining these early outcome metrics, this report begins to establish a framework for comparative effectiveness studies of this platform.