Robotik Pankreas Cerrahisi
Özet
Robotik pankreas cerrahisi, gelişen teknolojiyle birlikte teknik zorlukları ve karmaşık anatomik rekonstrüksiyonları aşmada giderek daha fazla önem kazanmaktadır. Intuitive Surgical firmasının Da Vinci platformu dünyada en yaygın kullanılan sistem olup, cerrahlara yüksek çözünürlüklü 3 boyutlu görüntü ve el titremesini ortadan kaldıran üstün hareket kabiliyeti sunmaktadır. Pankreatoduodenektomi (Whipple) gibi kompleks ameliyatlarda robotik yaklaşım, açık cerrahiye kıyasla operatif kan kaybını ve hastanede kalış süresini belirgin şekilde azaltmaktadır. Kısa vadeli onkolojik sonuçlar ile morbidite ve mortalite oranları açısından açık teknikle en azından eşdeğer başarıya sahiptir. Robotik distal pankreatektomide ise dalak koruma oranları, laparoskopik ve açık yaklaşımlara göre çok daha yüksek düzeydedir. Beger, Frey ve enükleasyon gibi diğer sınırlı prosedürlerde de robot kullanımı yaygınlaşmakla birlikte daha geniş serilere ihtiyaç duyulmaktadır. Bu sistemlerin en belirgin dezavantajları yüksek sermaye ve hizmet maliyetleri ile dokunsal geri bildirim eksikliğidir. Sonuç olarak robotik pankreas cerrahisi, uygun hasta seçimiyle güvenli ve etkin bir minimal invaziv alternatiftir.
Robotic pancreatic surgery is becoming increasingly significant in overcoming technical challenges and complex anatomical reconstructions thanks to advancing technology. Intuitive Surgical's Da Vinci platform is the most widely used system globally, providing surgeons with high-resolution 3D visualization and superior dexterity that eliminates hand tremors. In complex procedures like pancreatoduodenectomy (Whipple), the robotic approach significantly reduces operative blood loss and hospital stay compared to open surgery. It demonstrates at least equivalent success to open techniques regarding short-term oncological outcomes, morbidity, and mortality rates. Furthermore, robotic distal pancreatectomy offers substantially higher splenic preservation rates than laparoscopic and open approaches. Although the use of robotics is expanding in other limited procedures such as Beger, Frey, and enucleation, larger clinical series are still required. The most prominent disadvantages of these systems remain high capital and maintenance costs, alongside the lack of tactile feedback. In conclusion, robotic pancreatic surgery represents a safe and effective minimally invasive alternative when combined with proper patient selection.
Referanslar
Diana M, Marescaux J. Robotic surgery. Br J Surg. 2015; 102: e15-28.
Kausch W: Das carcinoma der papilla duodeni und seine radikale entfeinung. Beitr Z Clin Chir 1912;78:439–486.
Lieberman MD, et al.: Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638–645.
Winter JM, et al.: One thousand and twenty three pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10:1199–1210;discussion 1210–1.
Orr RK: Outcomes in pancreatic cancer surgery. Surg Clin North Am 2010;90:219–234.
Yeo CJ: Intraductal papillary mucinous neoplasms of the pancreas. Adv Surg 2002;36:15–38.
Cameron JL, et al.: One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15.
Gagner M, Pomp A: Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994;8:408–410.
Wilson CB: Adoption of new surgical technology. BMJ 2006;332:112–114.
Barkun JS, et al.: Evaluation and stages of surgical innovations. Lancet 2009;374:1089–1096.
Bethea BT, et al.: Application of haptic feedback to robotic surgery. J Laparoendosc Adv Surg Tech A 2004;14:191–195.
Gagner M, Pomp A: Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg 1997;1:20–25;discussion 25–6.
Polanco PM, Zenati MS, Hogg ME et al. An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions. Surg. Endosc. 2016; 30: 1523–9.
Napoli N, Kauffmann EF, Menonna F et al. Robotic versus open pancreatoduodenectomy: a propensity core-matched analysis based on factors predictive of postoperative pancreatic fistula. Surg. Endosc. 2018; 32: 1234–47.
Giulianotti PC, et al.: Robotics in general surgery: Personal experience in a large community hospital. Arch Surg 2003;138:777–784.
Chalikonda S, Aguilar-Saavedra JR, Walsh RM: Laparoscopic robotic-assisted pancreaticoduodenectomy: A case-matched comparison with open resection. Surg Endosc 2012;26:2397–2402.
Narula VK, Mikami DJ, Melvin WS: Robotic and laparoscopic pancreaticoduodenectomy: A hybrid approach. Pancreas 2010;39: 160–164.
Fernandes E, Giulianotti PC: Robotic-assisted pancreatic surgery. J Hepatobiliary Pancreat Sci 2013.
Zhang J, et al.: Robotic versus open pancreatectomy: A systematic review and meta-analysis. Ann Surg Oncol 2013;20:1774–1780.
Nigri G, et al.: Duodenopancreatectomy: Open or minimally invasive approach? Surgeon 2014;12:227–234.
Chen Y, et al.: A meta-analysis of robotic-assisted pancreatectomy versus laparoscopic and open pancreatectomy. Saudi Med J 2013;34:1229–1236.
Rosales-Velderrain A, et al.: National trends in resection of the distal pancreas. World J Gastroenterol 2012;18:4342–4349.
Kendrick ML: Laparoscopic and robotic resection for pancreatic cancer. Cancer J 2012;18:571–576.
Mabrut JY, et al.: Laparoscopic pancreatic resection: Results of a multicenter European study of 127 patients. Surgery 2005;137:597–605.
Melotti G, et al.: Laparoscopic distal pancreatectomy: Results on a consecutive series of 58 patients. Ann Surg 2007;246:77–82.
Kooby DA, et al.: Left-sided pancreatectomy: A multicenter comparison of laparoscopic and open approaches. Ann Surg 2008;248:438–446.
Abu Hilal M, et al.: Laparoscopic versus open distal pancreatectomy: A clinical and cost-effectiveness study. Surg Endosc 2012;26:1670–1674.
Waters JA, et al.: Robotic distal pancreatectomy: Cost effective? Surgery 2010;148:814–823.
Daouadi M, et al.: Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 2013;257:128–132.
Zureikat AH, et al.: Two hudred and fifty robotic pancreatic resections: Safety and feasibility. Ann Surg 2013;258:554–559; discussion 559–62.
Shoup M, et al.: The value of splenic preservation with distal pancreatectomy. Arch Surg 2002;137:164–168.
Jung MK, et al.: Robotic distal pancreatectomy: A valid option? Minerva Chir 2013;68:489–497.
Kang CM, et al.: Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 2011;25:2004–2009.
Waters JA, et al.: Robotic distal pancreatectomy: Cost effective? Surgery 2010;148:814–823.
Peng CH, et al.: Early experience for the robotic duodenumpreserving pancreatic head resection. World J Surg 2012;36:1136– 1141.
Dedieu A, et al.: Laparoscopic enucleation of pancreatic neoplasm. Surg Endosc 2011;25:572–576.
Fernandez-Cruz L, et al.: Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours. HPB (Oxford) 2012;14:171–176.
Kuroki T, Eguchi S: Laparoscopic parenchyma-sparing pancreatectomy. J Hepatobiliary Pancreat Sci 2014;21:323–327.
Sutherland DE, Matas AJ, Najarian JS: Pancreatic islet cell transplantation. Surg Clin North Am 1978;58:365–382.
Talamini G, et al.: Outcome and quality of life in chronic pancreatitis. JOP 2001;2:117–123.
Ahmad SA, et al.: Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg 2005;201:680–687.
Desai CS, et al.: Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. J Am Coll Surg 2011;213:e29–e34.
