RESUMO
Robotic pancreaticoduodenectomy (PD) remains one of the most advanced robotic procedures. Improved ergonomics and stable 3D vision with robotic platform helped overcome the technical challenges of pancreatic reconstruction in minimally invasive PD. However, inadequate understanding of the complex vascular anatomy of the pancreatic head and uncinate process often results in intra-operative bleeding and prolongs the learning curve. The technique of precise identification and systematic control of the vessels supplying the head and the uncinate process is described in this report. A good understanding of the common vascular anatomy and variations along with stepwise precise vascular control described in this report could minimise intra-operative bleeding and shorten the learning curve associated with robotic PD.
RESUMO
Incidence as a measure of risk for development of cancer is a well accepted epidemiological concept which can be precisely defined. The present communication documents an estimate of the current probability of development of cancer for specific age groups as well as for entire life time risk at the India country level for several cancers and 'all sites together'. The published data on age specific cancer incidence rates from 12 population based registries located at various parts of the country along with the abridged life tables relating to the Indian population formed the basic material for computation. Employing life table methodology for estimates, the current probability of developing cancer of all sites from 35-64 years is 4.67% in males and 6.55% in females while life time risk was found to be 9.05% and 10.2% respectively. The greater risk in females was mainly due to the high risk of development of cancer of the uterine cervix and breast. When the age-period of 35 to 70+ years were considered, the probability percentage was found to be 9.94 % in males whereas it was 11.6% in females. According to these estimates 1 in 10 men and 1 in 8 women in India can expect develop cancer of any form, in their life span after the age of 35 years. The probability of developing tobacco related cancers from 35 to 70+ years was found to be 4.75% and 2.16% in males and females respectively. Estimation in terms of probability will be useful in evaluating the changes in the disease spectrum as a result of change in mortality experience and population structure over a period of time.