RESUMO
INTRODUCTION: There has been a rapid development in minimally invasive pancreas surgery in recent years. The most recent innovation is robotic pancreatoduodenectomy. Several studies have suggested benefits as compared to the open or laparoscopic approach. This review provides an overview of studies concerning patient selection, volume criteria, and training programs for robotic pancreatoduodenectomy and identified knowledge gaps regarding barriers for safe implementation of robotic pancreatoduodenectomy. MATERIALS AND METHODS: A Pubmed search was conducted concerning patient selection, volume criteria, and training programs in robotic pancreatoduodenectomy. RESULTS: A total of 20 studies were included. No contraindications were found in patient selection for robotic pancreatoduodenectomy. The consensus and the Miami guidelines advice is a minimum annual volume of 20 robotic pancreatoduodenectomy procedures per center, per year. One training program was identified which describes superior outcomes after the training program and shortening of the learning curve in robotic pancreatoduodenectomy. CONCLUSION: Robotic pancreatoduodenectomy is safe and feasable for all indications when performed by specifically trained surgeons working in centers who can maintain a minimum volume of 20 robotic pancreatoduodenectomy procedures per year. Large proficiency-based training program for robotic pancreatoduodenectomy seem essential to facilitate a safe implementation and future research on robotic pancreatoduodenectomy.
Assuntos
Pancreatopatias/cirurgia , Pancreaticoduodenectomia , Seleção de Pacientes , Procedimentos Cirúrgicos Robóticos , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Educação/normas , Educação/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Laparoscopia , Curva de Aprendizado , Procedimentos Cirúrgicos Minimamente Invasivos , Pancreaticoduodenectomia/educação , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/normas , Pancreaticoduodenectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos , Resultado do TratamentoRESUMO
AIM: Parastomal hernia commonly occurs following the formation of a stoma. This is a review of parastomal hernia repair using a modified lateral approach to access the defect. PATIENTS/METHODS: A case series of 17 patients, with a median age of 65, who underwent parastomal hernia repair via a lateral approach over a five year period, is presented. RESULTS: Of the 17 repairs, there were four minor complications in the form of a superficial cellulitis and conservatively managed ileus. In total there were four recurrences, though only one recurrence occurred in 11 cases after slight modification of the technique. The period of follow-up ranged from 6 to 60 months. DISCUSSION: The lateral approach is a viable option for repair of parastomal hernia. It does not necessitate a laparotomy or relocation of the stoma.