Clinical Application Research Of Minimally Invasive Pancreaticoduodenectomy With "G" Shaped Surgical Approach

Objective:To introduce the "G" shaped approach of laparoscopic and robotic pancreaticoduodenectomy,and to explore its feasibility,safety,effectiveness,and its application value in the early stage of minimally invasive pancreaticoduodenectomy,and to summarize clinical experience.Methods:The clinical data of 28 patients performed MIDP from May 2015 to March 2018 in the First Hospital of Shanxi Medical University were analyzed retrospectively.Among them,16 patients underwent Laparoscopic pancreatoduodenectomy(LPD)and 12 patients underwent Robotic pancreatoduodenectomy(RPD).The above is used as a minimally invasive group.At the same time,the data of 25 patients with OPD operation were collected and used as a control group.The statistical description of numerical variables uses mean±standard deviation(X±S),Chi square test and Fisher 's exact probability method was used for the comparison of variable data groups,The normal distribution of measurement data is checked by using single sample K-S normal distribution test.The measurement data belonging to the normal distribution,use the t test,belonging to the comparison of the non-normal distribution of the measurement data,use the nonparameter test(Mann-Whitney U method).The difference was statistically significant with P < 0.05.Results:From May 2015 to March 2018,28 cases of minimally invasive pancreaticoduodenectomy with "G" shaped surgical procedures were completed in the first hospital of Shanxi Medical University.The 28 patients completed the operation successfully,and no case died during perioperative period.The average Excision time of surgical specimens was 217.5±56.2min(130-347min),the mean operative time was 441.6 ± 79.1(280-630min),and the operative blood loss was 253.6 ± 172.1ml(50-600ml),The median is 225 ml.The number of lymph node dissections was 6.7±3.6,The median is 5.5,and the average hospitalization time after operation was 21.2 + 7.7 days(13-41 days),The median is 19 d.The average time of postoperative dietary intake of fluid was 4.1±2.1 days,The median is 3d.Compared with the 25 OPD cases in the same period,The amount of bleeding in the minimally invasive group during operation,postoperative feeding liquid diet time,postoperative hospitalization time less than the open group,the difference was statistically significant(P < 0.05).There was no significant difference in the number of lymph node dissection,Intraoperative blood transfusion,postoperative complications,postoperative ICU and re-operation rate.(P > 0.05).Conclusion:Laparoscopic and robotic pancreaticoduodenectomy with "G" shaped approach is safe and feasible.It is suitable for the operation performer at preliminary stage in the learning curve of the Minimally invasive pancreatoduodenectomy and the clinical promotion.