Surgical Strategies to Approaching the Splenic Artery in Robotic Distal Pancreatectomy
Surgical Strategies to Approaching the Splenic Artery in Robotic Distal Pancreatectomy
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DOI：
10.21873/anticanres.15947
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发表时间：
2022-09-01
影响因子：
2
通讯作者：
Fujiwara, Toshiyoshi
中科院分区：
文献类型：
--
作者：
Takagi, Kosei;Kumano, Kenjiro;Fujiwara, Toshiyoshi
背景/目的：了解不同的手术入路和邻近脾动脉（SpA）的解剖标志对于安全的机器人远端胰腺切除术（RDP）非常重要。在这里，我们提出了我们的标准化RDP技术，专注于这些问题。患者和方法：回顾了2021年4月至2022年4月期间在我们机构接受RDP的19例患者。SpA的解剖类型分为3种类型：1型，SpA根部无胰腺实质; 2型，SpA根部有胰腺实质; 3型，SpA与肝总动脉分叉处周围有胰背动脉。接下来，根据胰腺横断线的位置确定接近SPA的手术策略：在上级肠系膜静脉（SMV）上或SpA根部左侧。结果：1型7例，2型9例，3型3例。当在SMV上横断胰腺时，SpA先结扎技术用于1型SpA解剖，胰腺先分离技术用于2型和3型SpA解剖。在SpA根部左侧横断胰腺的患者中，使用SpA优先结扎技术。结论：我们的标准化手术策略的基础上，解剖标志，并专注于该方法的SpA在RDP的证明。我们的策略应该帮助受训者接近SpA并安全地执行RDP。
Background/Aim: Understanding different surgical approaches and anatomical landmarks adjacent to the splenic artery (SpA) is important for safe robotic distal pancreatectomy (RDP). Herein, we propose our standardized RDP techniques, focusing on these issues. Patients and Methods: Between April 2021 and April 2022, 19 patients who underwent RDP at our Institution were reviewed. Anatomical patterns of the SpA were classified into three types: Type 1, no pancreatic parenchyma on the root of the SpA; type 2, any pancreatic parenchyma on the root of the SpA; and type 3, dorsal pancreatic artery around the bifurcation of the common hepatic artery and SpA. Next, the surgical strategy for approaching the SPA was determined according to the location of the pancreatic transection line: On the superior mesenteric vein (SMV) or on the left side of the root of the SpA. Results: There were seven cases of type 1, nine cases of type 2, and three cases of type 3. When transecting the pancreas on the SMV, the SpA-first ligation technique was used for type 1 SpA anatomy, and the pancreas-first division technique was applied for types 2 and 3. In patients in whom the pancreas was transected at the left side of the root of the SpA, the SpA-first ligation technique was used. Conclusion: Our standardized surgical strategy based on anatomical landmarks and focusing on the approach to the SpA in RDP is demonstrated. Our strategy should help trainees approach the SpA and perform RDP safely.