Медицинская литература. Новинки

 

 

 

 

 

 

Робот-ассистированные операции на поджелудочной железе (обзор литературы)

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Цель исследования: систематизировать данные мировой литературы о применении робот-ассистированной технологии в хирургии поджелудочной железы. Материал и методы. Проанализирована 31 публикация за период с 2010 по 2014 г. В работах освещен опыт 856 робот-ассистированных операций на поджелудочной железе. Результаты. Наибольшее число робот-ассистированных операций на поджелудочной железе (90%) составляют панкреатодуоденальная и дистальная резекции - 55 и 35% соответственно. Средняя продолжительность робот-ассистированной панкреатодуоденальной резекции составила 342 ± 209 мин, дистальной резекции - 200 ± 131,9 мин. Средняя величина кровопотери при робот-ассистированной операции относилась к I степени тяжести согласно классификации ВОЗ 2001 г. Отмечено увеличение числа осложнений после робот-ассистированных вмешательств по мере увеличения числа операций на поджелудочной железе. Заключение. Проведенный анализ литературы демонстрирует возрастающий интерес хирургов-панкреатологов к использованию робототехники. В то же время отсутствует единая концепция применения роботического комплекса в хирургии поджелудочной железы, не сформулированы четкие показания и противопоказания к робот-ассистированным операциям на поджелудочной железе. Отсутствует методологическая база, описывающая технические аспекты выполнения этих сложных вмешательств. Устранение указанных недостатков делает актуальными продолжающиеся исследования по использованию робот-ассистированной технологии.

Ключевые слова:
поджелудочная железа, миниинвазивная хирургия, робот-ассистированные операции, резекция, осложнения, pancreas, mini-invasive surgery, robot-assisted operations, resection, complications

Литература:
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6.Cheng K., Shen B., Peng C., Deng X., Hu S. Initial experiences in robot-assisted middle pancreatectomy. HPB (Oxford). 2013; 15 (4): 315-321. DOI: 10.1111/j.1477-2574.2012.00605.x.
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8.Choi S.H., Kang C.M., Kim D.H., Lee W.J., Chi H.S. Robotic pylorus preserving pancreaticoduodenectomy with minilaparotomy reconstruction in patient with ampullary adenoma. J. Korean Surg. Soc. 2011; 81 (5): 355-359. DOI: 0.4174/jkss.2011.81.5.355.
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11.De Vasconcellos A.L., Schraibman V., Okazaki S., Concilio F., Epstein M.G., Goldman S.M., Lustosa S.A., Matos D. Treatment of intraductal papillary mucinous neoplasms, neuroendocrine and periampullary pancreatic tumors using robotic surgery: a safe and feasible technique. J. Robotic Surg. 2011; 5 (1): 35-41. DOI: 10.1007/s11701-010-0238-3.
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16.Hammill C., Cassera M., Swanstrom L., Hansen P. Robotic assistance may provide the technical capability to perform a safe, minimally invasive pancreaticoduodenectomy. HPB. 2010; 12 (1): 198.
17.Horiguchi A., Uyama I., Ito M., Ishihara S., Asano Y., Yamamoto T., Ishida Y., Miyakawa S. Robot-assisted laparoscopic pancreatic surgery. J. Hepatobiliary Pancreat. Sci. 2011; 18 (4): 488-492. DOI: 10.1007/s00534-011-0383-8.
18.Hwang H.K., Kang C.M., Chung Y.E., Kim K.A., Choi S.H., Lee W.J. Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon''s experiences and proposal of clinical application. Surg. Endosc. 2013; 27 (3): 774-781. DOI: 10.1007/s00464-012-2551-6.
19.Kang C.M., Kim D.H., Lee W.J., Chi H.S. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg. Endosc. 2010; 25 (6): 2004-2009. DOI: 10.1007/s00464-010-1504-1.
20.Kang C.M., Kim D.H., Lee W.J., Chi H.S. Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy. Surg. Endosc. 2011; 25 (4): 1101-1106. DOI: 10.1007/s00464-010-1324-3.
21.Lai E.C., Yang G.P., Tang C.N. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy - a comparative study. Int. J. Surg. 2012; 10 (9): 475-479. DOI: 10.1016/j.ijsu.2012.06.003.
22.Narula V.K., Mikami D.J., Melvin W.S. Robotic and laparoscopic pancreaticoduodenectomy: a hybrid approach. Pancreas. 2010; 39 (2): 160-164. DOI: 10.1097/MPA.0b013e3181bd604e.
23.Suman P., Rutledge J., Yiengpruksawan A. Robotic spleen preserving distal pancreatectomy is safe and feasible. Gastroenterology. 2012; 142 (5): 1060-1061. DOI: 10.1016/s0016-5085(12)64114-6.
24.Boggi U., Signori S., de Lio N., Perrone V.G., Vistoli F., Belluomini M., Cappelli C., Amorese G., Mosca F. Feasibility of robotic pancreatoduodenectomy. Br. J. Surg. 2013; 100 (7): 917-925. DOI: 10.1002/bjs.9135.
25.Walsh M., Chalikonda S., Saavedra J.R.A., Lentz G., Fung J. Laparoscopic robotic assisted Whipple: early results of a nove technique and comparison with the standard open procedure. Surg. Endosc. 2011; 25 (9): 221-223. DOI: 10.1007/s00464-012-2207-6.
26.Waters J.A., Canal D.F., Wiebke E.A., Dumas R.P., Beane J.D., Aguilar-Saavedra J.R., Ball C.G., House M.G., Zyromski N.J., Nakeeb A., Pitt H.A., Lillemoe K.D., Schmidt C.M. Robotic distal pancreatectomy: cost effective? Surgery. 2010; 148 (4): 814-823. DOI: 10.1016/j.surg.2010.07.027.
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Robot-Assisted Pancreatic Surgery (Review)

Aim. To systematize world literature data for robot-assisted pancreatic surgery. Material and methods. 31 publications for the period 2010-2014 were analyzed. In these articles 856 robot-assisted pancreatic operations were assessed. Results. 90% of robot-assisted pancreatic operations include pancreaticoduodenectomy (55%) and distal pancreatectomy (35%). Median time of robot-assisted pancreatoduodenectomy was 342 ± 209 minutes, distal pancreatectomy time - 200 ± 131.9 minutes. Median blood loss during robot - assisted operations was referred to class 1 by WHO (2001) classification. The number of complications is increased as far as the number of robotic assisted operations is augmented. Conclusion. Analyses demonstrates growing interest of pancreatic surgeons in robotic technologies. At the same time there is no unique strategy of robotic pancreatic surgery. Certain indications and contraindications for pancreatic robot-assisted surgery are absent. There is no methodological base describing technical aspects of these difficult interventions. So, further researches of robot-assisted techniques are advisable to eliminate these limitations.

Keywords:
поджелудочная железа, миниинвазивная хирургия, робот-ассистированные операции, резекция, осложнения, pancreas, mini-invasive surgery, robot-assisted operations, resection, complications