Robotic pancreatoduodenectomy for a solid pseudopapillary tumor in a ten-year-old child
| Autor: | Carolijn L.M.A. Nota, Jeroen Hagendoorn, Inne H.M. Borel Rinkes, I. Quintus Molenaar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Abdominal pain Supine position Pancreatic Neoplasms/pathology Video-Assisted Surgery Video-Assisted Surgery/methods Case Reports Pancreaticoduodenectomy Laparoscopy/methods Carcinoma Papillary/pathology 03 medical and health sciences 0302 clinical medicine Robotic Surgical Procedures Journal Article Medicine Papillary/pathology Humans Child Minimally invasive procedures Gastric emptying business.industry Whipple resection Carcinoma Robotic Surgical Procedures/methods Prognosis Working space Carcinoma Papillary Surgery Pancreatic Neoplasms Solid pseudopapillary tumor Pancreaticoduodenectomy/methods Oncology 030220 oncology & carcinogenesis Laparoscopy 030211 gastroenterology & hepatology Female medicine.symptom business Robotic arm |
| Zdroj: | Surgical Oncology, 27(4), 635. Elsevier Ireland Ltd |
| ISSN: | 0960-7404 |
| Popis: | Background Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [ 1 ]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open surgery [ 2 ], it remains to be determined whether the pediatric population may potentially benefit from this minimally invasive procedure. Here we present, for the first time, a video of setup and surgical technique of robotic pancreatoduodenectomy in a child. Methods A 10-year-old girl presented with complaints of fullness and abdominal pain in the upper quadrants. Investigations including a diffusion-weighted, pancreatic MR scan suggested the diagnosis of solid pseudopapillary tumor (Frantz's tumor). The patient was considered for robotic pancreatoduodenectomy. Results After anesthesia, the patient was placed supine on a split-leg table. Trocar placement was adjusted to accommodate the child's length and body weight, according to pre-operatively calculated positions that would allow for maximum working space and minimize inadvertent collision between the robotic arms. The da Vinci Si surgical robot was positioned in-line towards the surgical target and all four robotic arms were docked, while two additional laparoscopic ports were placed for tableside assistance. After standard pancreatoduodenectomy, a conventional loop reconstruction was performed including an end-to-side pancreaticojejunostomy with duct-to-mucosa technique and stapled side-to-side gastrojejunostomy. We suggest that in this patient group, pylorus preserving pancreatoduodenectomy with end-to-side duodenojejunostomy may be a suitable alternative. Postoperative recovery was complicated by delayed gastric emptying but otherwise unremarkable. Hospital length of stay was 12 days. Final pathology demonstrated a solid pseudopapillary tumor with negative surgical margins. Conclusion This case illustrates the feasibility of robotic pancreatoduodenectomy in children. Essential elements of this procedure are a well-running robotic pancreatic surgery program as well as careful preoperative port placement planning. |
| Databáze: | OpenAIRE |
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