The Clinical Significance Of The Distribution Of Pancreatic Veins In The Davinci Robotic Kimura Spleen-Preserving Distal Pancreatectomy

Objective:The main method for treating tumors in distal pancreas is distal pancreatectomy.In recent years,the concept of "preserving the spleen as much as possible and avoiding innocent resection" has been widely recognized by surgeons.The most important thing to preserve the spleen is to ensure that the blood supply of spleen can be effectively preserved after pancreatectomy.The Kimura technique(KT)is often given priority because it preserves all the splenic vessels,which is consistent with the physiological structure.The incidence rate of splenic abscess,secondary infection,splenic infarction and regional portal hypertension after surgery is low.The advantages of Davinci robotic Kimura spleen-preserving distal pancreatectomy in preserving organ function and long-term postoperative recovery have been widely recognized.Our research aims to explore the distribution of pancreatic veins through three-dimensional(3D)reconstruction technology,and guide the selection of surgical methods,so as to improve the success rate of Davinci robotic Kimura spleen-preserving distal pancreatectomy.Methods:From January 2014 to September 2021,we conducted a study on consecutive patients with benign or low-grade malignant tumors of the distal pancreas who were treated by Davinci robotic spleen-preserving distal pancreatectomy(RSPDP)in the Shinan Hospital of the Affiliated Hospital of Qingdao University.A comprehensive retrospective collection of preoperative,intraoperative,and postoperative data was conducted,and detailed follow-up was conducted on the patient’s platelet count,delayed gastric emptying,abdominal infection,and splenic infarction.Import the DICOM(digital imaging and communication of medicine)format data collected from preoperative enhanced CT of patients into our hospital’s Hisense CAS 3D reconstruction system.Under the guidance of imaging physicians and 3D reconstruction engineers,calibration and 3D reconstruction of venous phase image data are carried out,including liver,pancreas,tumors,portal vein,spleen,and with a focus on the reconstruction of pancreatic veins.The 3D reconstruction model was imported into 3D Slicer software for data measurement: The number of pancreatic veins;the Length of splenic veins(cm);pancreatic vein density(number/cm);the range of distribution angles of pancreatic veins.Quantitative analysis of the distribution rules of pancreatic veins in patients through 3D reconstruction.Compare the clinical data of patients in Kimura group and Warshaw group,evaluate the risk factors of failure of Kimura technique,and use Logistic regression model to predict the choice of operation method.Further compare the differences in the distribution of pancreatic veins between Kimura group and Warshaw group,and propose the distribution rules of pancreatic veins.Results:A total of 73 patients were included in the study,including 40 Kimura technique and 33 Warshaw technique.Finally,the 3D reconstruction was completed by 30 patients in the Kimura group and 24 patients in the Warshaw group.Logistic multivariate analysis confirmed that the number of branches of pancreatic veins(P<0.01),the range of distribution angles of pancreatic veins(P<0.05)and preoperative albumin(P<0.05)were independent predictors of Kimura surgery success.The number of branches of pancreatic vein in Kimura group was 6.00(6.00-7.00),and that in Warshaw group was 8.00(6.25-9.00).The density of pancreatic vein branches in Kimura group was 0.49 ± 0.11 branches/cm,and the number of pancreatic vein branches in Warshaw group was 0.61 ± 0.15 branches/cm.3D reconstruction analysis showed that the pancreatic vein in Kimura group was distributed within 71.13 ± 9.54 ° in front of the human coronal section of splenic vein,and the pancreatic vein in Warshaw group was distributed within 83.95 ± 17.64 ° in front of the human coronal section of splenic vein.Using R software and drawing a personalized nomogram model that can predict the success rate of Kimura surgery,the C index of the model is 0.862,and internal validation shows that the model has good predictive accuracy.Conclusion:A risk model was established through 3D reconstruction and other methods,combined with clinical data.This study can demonstrate the distribution roles of pancreatic veins.Preoperative 3D reconstruction can provide the necessary basis for Davinci robotic spleenpreserving distal pancreatectomy,improve the success rate and safety of Kimura surgery,reduce complications,and promote the development of Davinci robot technology.