Robotic Pancreatoduodenectomy With G-shaped Path And Modified Pancreatojejunostomy

Objective:Summarize the clinical experience of robotic duodenal resection using the "G" shaped surgical approach.Methods:The clinical data of 15 patients who were undergoing robotic PD performed at the First Affiliated Hospital of Shanxi Medical University was collected during the period 2017.06-2018.03.The Da Vinci Si operation system was used in th e surgeries,and it was taken by the ingenious G-shaped path of our group.The operations included the excision of distal stomach,duodenal artery,gallbladder,du odenum,and pancreas,as well as the digestive tract reconstruction combined with gastrointestinal anastomosis,bilioenteric anastomosis,and pancreaticojejunostomy.Whereas a modified suture technique was used while suturing pancreatic intestinal anastomos.Results:All the 15 operations were performed successfully.The average time was 499.0min(350min-825min),and the average blood loss was 119.3ml(20ml-500ml).All surgical margins were negative.Postoperative pathological analysis: there are 1 pancreatic head cancer,1 duodenal stromal tumor,2 periampullary cancer,5 duodenal cancer,and 6 lower bile duct cancer in all the 15 patients.All patien ts recovered well after surgeries,and the average postoperative hospital stay was21.4 days(14 days-36 days).However,one patient experienced secondary surge ry due to bilioenteric anastomosis fistula,fortunately the surgical process went suc cessfully.This patient had pancreatic leakage(class B)after surgery and was disc harged with tubes after a conservative treatment.Another patient had gastroplegia and recovered completely after conservative treatment.Conclusion:Compared with the conventional robotic PD,the robotic PD with G-shaped p ath and modified pancreaticojejunostomy shows good performance in the amount of intraoperative blood loss and postoperative complications,especially the control of pancreatic leakage,whereas,it is similar in terms of operating time,negative surgical margin,and postoperative hospital stay,etc.Therefore,we believe that it is a safe and feasible procedure to use the robotic PD with a G-shaped path and a modified pancreaticojejunostomy and which is worth promoting.The same path used in the early application of laparoscopic surgery can reduce the difficulty of robotic surgery,shorten the operation time,and improve the quality of the surge ry,which therefore optimizes the learning curve of robotic PD.