Robotisch gestützte Enukleation einer zystischen Neoplasie des Pankreaskopfes

Zusammenfassung

Laut aktuellen revidierten Fukuoka-Leitlinien besteht die Indikation zur Resektion von BD-IPMN des Pankreas mit Worrisome Features, da hier ein Risiko der malignen Entartung von bis zu 30% besteht. Die Resektion kann bei fehlenden klinischen, bildmorphologischen und laborchemischen Malignitätszeichen als eine nicht anatomische, lokale Exzision durchgeführt werden.

Eine robotische Enukleation bei benignen Raumforderungen der Bauchspeicheldrüse stellt eine sehr gute Alternative zu den resezierenden Verfahren, insbesondere zu denjenigen in offener Technik, dar. Diese operative Behandlungsoption wird bei einem Mindestabstand bis zum pankreatischen Hauptgang von mindestens 2 mm im „International consensus statement on robotic pancreatic surgery“ nahegelegt.

Neben den bekannten Vorteilen der minimalinvasiven Chirurgie führt diese parenchymsparende Methode zum Erhalt von endo- und exokriner Funktion (ca. 90%) und zu einem progressfreien 10-Jahres-Überleben von ca. 75% bei etwas erhöhter Morbidität (ca. 60%) verglichen mit den resezierenden Verfahren.

Der folgende Videobeitrag präsentiert das Operationsvideo einer robotischen Zystenenukleation (bei Verdacht auf eine BD-IPMN mit Worrisome Features) im Pankreaskopf und Processus uncinatus bei einer 62-jährigen Patientin mit besonderer Betonung der wichtigsten vaskulären Landmarken, Besonderheiten der Herangehensweise und Vorteile der robotischen Technik.

Abstract

According to current revised Fukuoka guidelines, there is an indication for resection of BD-IPMN of the pancreas with “worrisome features”, as there is a risk of malignant degeneration of up to 30%. This can be performed as a non-anatomical local excision in the absence of clinical, radiological and laboratory signs of malignancy.

Robotic enucleation for benign tumours of the pancreas is a very good alternative to resecting procedures, especially those using open techniques. This surgical treatment option is recommended by the “International consensus statement on robotic pancreatic surgery” in a case of a minimum distance to the main pancreatic duct of at least 2 mm.

In addition to the known advantages of minimally invasive surgery, this parenchyma-sparing approach results in preservation of endo- and exocrine function (ca. 90%) and 10-year progression-free survival of ca. 75% with slightly increased morbidity (ca. 60%) compared with resecting procedures.

The following video article presents the surgical video of a robotic cyst enucleation (for suspected BD-IPMN with “worrisome features”) in the pancreatic head and uncinate process in a 62-year-old female patient with special emphasis on the most important vascular landmarks, special features of the approach and advantages of the robotic technique

Schlüsselwörter

Pankreaschirurgie - IPMN - Robotic - Enukleation - minimalinvasiv - parenchymsparend

Keywords

pancreatic surgery - IPMN - robotics - enucleation - minimally invasive - parenchym sparing

Publication History

Received: 31 January 2022

Accepted: 08 February 2022

Article published online:
04 April 2022

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