摘要
BACKGROUND Walled-off pancreatic necrosis(WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi.CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound(US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through theanastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection.CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
BACKGROUND Walled-off pancreatic necrosis(WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi.CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound(US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through theanastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection.CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
引文
1 Connor S,Raraty MG,Howes N,Evans J,Ghaneh P,Sutton R,Neoptolemos JP.Surgery in the treatment of acute pancreatitis--minimal access pancreatic necrosectomy.Scand J Surg 2005;94:135-142[PMID:16111096 DOI:10.1177/145749690509400210]
2 Sarr MG.2012 revision of the Atlanta classification of acute pancreatitis.Pol Arch Med Wewn 2013;123:118-124[PMID:23396317 DOI:10.1136/gutjnl-2012-304051]
3 Bo?koski I,Costamagna G.Walled-off pancreatic necrosis:where are we?Ann Gastroenterol 2014;27:93-94[PMID:24733647]
4 Kulkarni S,Bogart A,Buxbaum J,Matsuoka L,Selby R,Parekh D.Surgical transgastric debridement of walled off pancreatic necrosis:an option for patients with necrotizing pancreatitis.Surg Endosc 2015;29:575-582[PMID:25055889 DOI:10.1007/s00464-014-3700-x]
5 Nassour I,Ramzan Z,Kukreja S.Robotic cystogastrostomy and debridement of walled-off pancreatic necrosis.J Robot Surg 2016;10:279-282[PMID:27039191 DOI:10.1007/s11701-016-0581-0]
6 Kirks RC,Sola R,Iannitti DA,Martinie JB,Vrochides D.Robotic transgastric cystgastrostomy and pancreatic debridement in the management of pancreatic fluid collections following acute pancreatitis.JVis Surg 2016;2:127[PMID:29078515 DOI:10.21037/jovs.2016.07.04]
7 Cardenas A,Abrams A,Ong E,Jie T.Robotic-assisted cystogastrostomy for a patient with a pancreatic pseudocyst.J Robot Surg 2014;8:181-184[PMID:27637530 DOI:10.1007/s11701-013-0428-x]
8 Redwan AA,Hamad MA,Omar MA.Pancreatic Pseudocyst Dilemma:Cumulative Multicenter Experience in Management Using Endoscopy,Laparoscopy,and Open Surgery.J Laparoendosc Adv Surg Tech A 2017;27:1022-1030[PMID:28459653 DOI:10.1089/lap.2017.0006]
9 Worhunsky DJ,Qadan M,Dua MM,Park WG,Poultsides GA,Norton JA,Visser BC.Laparoscopic transgastric necrosectomy for the management of pancreatic necrosis.J Am Coll Surg 2014;219:735-743[PMID:25158913 DOI:10.1016/j.jamcollsurg.2014.04.012]
10 ASGE Standards of Practice Committee.Muthusamy VR,Chandrasekhara V,Acosta RD,Bruining DH,Chathadi KV,Eloubeidi MA,Faulx AL,Fonkalsrud L,Gurudu SR,Khashab MA,Kothari S,Lightdale JR,Pasha SF,Saltzman JR,Shaukat A,Wang A,Yang J,Cash BD,DeWitt JM.The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections.Gastrointest Endosc 2016;481-488[PMID:26796695 DOI:10.1016/j.gie.2015.11.027]
11 Gerin O,Prevot F,Dhahri A,Hakim S,Delcenserie R,Rebibo L,Regimbeau JM.Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis(with video).Surg Endosc2016;30:1235-1241[PMID:26275532 DOI:10.1007/s00464-015-4331-6]
12 Dua MM,Worhunsky DJ,Malhotra L,Park WG,Poultsides GA,Norton JA,Visser BC.Transgastric pancreatic necrosectomy-expedited return to prepancreatitis health.J Surg Res 2017;219:11-17[PMID:29078869 DOI:10.1016/j.jss.2017.05.089]
13 Singh Y,Cawich SO,Olivier L,Kuruvilla T,Mohammed F,Naraysingh V.Pancreatic pseudocyst:combined single incision laparoscopic cystogastrostomy and cholecystectomy in a resource poor setting.JSurg Case Rep 2016;2016:pii:rjw176[PMID:27803243 DOI:10.1093/jscr/rjw176]
14 Smadja C,Badawy A,Vons C,Giraud V,Franco D.Laparoscopic cystogastrostomy for pancreatic pseudocyst is safe and effective.J Laparoendosc Adv Surg Tech A 1999;9:401-403[PMID:10522534DOI:10.1089/lap.1999.9.401]
15 George A,Panwar R,Pal S.Surgical Management of Life Threatening Bleeding after Endoscopic Cystogastrostomy.J Invest Surg 2017;1-6[PMID:28945487 DOI:10.1080/08941939.2017.1362081]
16 Nielsen OS.Bleeding after pancreatic cystogastrostomy.Acta Chir Scand 1979;145:247-249[PMID:494972]
17 Ikoma A,Tanaka K,Ishibe R,Ishizaki N,Taira A.Late massive hemorrhage following cystogastrostomy for pancreatic pseudocyst:report of a case.Surg Today 1995;25:79-82[PMID:7749296 DOI:10.1007/BF00309393]
18 Guerra F,Amore Bonapasta S,Annecchiarico M,Bongiolatti S,Coratti A.Robot-integrated intraoperative ultrasound:Initial experience with hepatic malignancies.Minim Invasive Ther Allied Technol 2015;24:345-349[PMID:25835093 DOI:10.3109/13645706.2015.1022558]