Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with portal vein resection and artificial vascular graft and reconstruction / 中华消化外科杂志

ABSTRACT

Objective To explore the application value of Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with portal vein (PV) resection and artificial vascular graft and reconstruction.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with cancer of pancreatic head combined with biliary and duodenal obstructions who was admitted to the Southwest Hospital of the Third Military Medical University in November 2015 were collected.Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction were applied to the patient due to intraoperative tumor extensive invasion to the PV and angiogenesis around the tumor.The operation time,volume of intraoperative blood loss and transfusion,time of postoperative drainage-tube removal,postoperative complications,result of postoperative pathological examination,duration of postoperative hospital stay and results of follow-up were observed.The follow-up of outpatient examination and telephone interview was performed to detect the survival of the patient up to February 2016.Results The patient underwent successful Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction.The length of intraoperative excisional PV,operation time,volume of intraoperative blood loss,volume of red blood cell suspension and blood plasma infusions were 3 cm,670 minutes,600 mL,400 mL and 200 mL,respectively.The patient got out-off-bed activity at postoperative day 1 and fluid diet intake after gastric-tube removal at postoperative day 3,and drainage-tube was removed at postoperative day 8.No postoperative complication was detected.The patient had unblocked main PV without obvious stenosis and filling defect by computer tomography rescanning.Adenosquamous carcinoma of the pancreatic head was confirmed by postoperative pathological examination.There were negative resection margins from the proximal and distal duodenum to the pancreas.The patient was discharged from hospital at postoperative day 12 and followed up for 3 months,with a good survival.Conclusions Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction are safe and feasible in the treatment of the cancer of pancreatic head combined with biliary and duodenal obstructions,with a good short-term outcome.