Objective To summarize the clinical experience of da Vinci surgical system in treatment for senile patients with severe obstructive jaundice．Methods From January 2009 to May 2011, 209 patients with hepatopancreatobiliary （HPB） diseases underwent robotic surgeries by using da Vinci surgical system. Forty-seven senile patients with severe obstructive jaundice were selected for robotic surgery （robot group） and 44 for open surgery（open group）.The distribution of disease, pro-, intra-, and post-operative data in the two groups were analyzed. Results Baseline of two groups was same. A total of 46 patients had underwent total robotic surgeries （97.87%，46/47） and 1 patient converted to hand-assisted procedure （2.13%，1/47）. Surgeries included all HPB difficult surgical procedures, also including 1 case of hilar cholangiocarcinoma patient who had high level serum bilirubin （375μmol/L）and underwent emergency resection for hilar cholangiocarcinoma and portal-jejunal Roux-en-Y anastomosis． Postoperative complications occurred in 7 cases （14.89%, 7/47） and 1 case died （2.13%, 1/47） . Three-month survival rate was 78.15%. Fifteen-day and 3-month after surgery, physical strength score was 42.87±18.61 and 58.51±23.86, respectively. The total length of abdominal incision was （6.30±1.70） cm. All the patients in the open group completed surgery, including emergency operation in 4 cases. Postoperative complications occurred in 13 cases （29.55%, 13/44） and 2 cases died （4.55%, 2/44）.Three-month survival rate was 72.36%. Fifteen-day and 3-month after surgery, physical strength score was 37.15±13.64 and 45.27±18.96, respectively. The total length of abdominal incision was （26.73±3.07） cm. There were significant differences of postoperative complications, postoperative 15-day and 3-month physical strength score, and incision length between two groups（P＜0.05）. Conclusions da Vinci surgical system is safe and effective in treatment for senile patients with severe obstructive jaundice.
ObjectiveTo summarize the clinical experience of 180 general surgeries under da Vinci surgical system. MethodsFrom January 2009 to October 2010, 180 patients with hepatopancreaticobiliary and gastrointestinal disease underwent robotic surgeries by using da Vinci surgical system. The case distribution, intra-and post-operative data were analyzed. ResultsA total of 171 patients had underwent total robotic surgeries and nine patients converted to hand-assisted procedure (5.0%, 9/180). The surgery for hepatic portal was performed in 63 cases of patients, including surgery for hilar cholangiocarcinoma in 36 cases, gallbladder carcinoma in 10 cases, complex calculus of intrahepatic duct in 12 cases, and iatrogenic biliary duct injury in 5 cases. The pancreatic surgery was performed in 44 cases of patients, including pancreatoduodenectomy in 16 cases, distal pancreatectomy in 6 cases, medial pancreatectomy in 1 case, pancreatic cyst-jejunum anastomosis in 1 case, and palliative surgery in 20 cases. Hepatic surgery was in 19 cases and gastrointestinal surgery in 12 cases of patients. Other procedures were in 42 cases of patients, including common bile duct exploration and removing the stone, retroperitoneal lymph nodes dissection, and splenectomy, etc. All of ten cases of patients with obstructive suppurative cholangitis received emergency surgery by the robot and postoperative infection symptoms were controlled, and shock was corrected quickly. No death occurred during the perioperative period. Postoperative complications occurred in 12 cases (6.7%, 12/180) and 2 cases died (1.1%, 2/180). Conclusionsda Vinci surgical system can carry out all kinds of general surgery, especially complicated and difficult hepatobiliary and pancreatic surgery, which improves the development of minimally invasive surgery.
ObjectiveTo summarize the clinical experience of 58 operations for biliary malignant tumor with da Vinci surgical system. MethodsFrom January 2009 to October 2010, 180 patients with hepatopancreaticobiliary and gastrointestinal disease underwent robotic surgeries by using da Vinci surgical system, including 58 patients with biliary malignant tumor. The case distribution, intra and postoperative data were analyzed. ResultsOf 58 patients, 3 patients with intrahepatic bile duct cystadenocarcinoma received wedge resections of liver. In 36 patients with hilar cholangiocarcinoma, anatomical left hemihepatectomies were performed in 3 cases, resection of extrahepatic duct and gallbladder bridge type biliary revascularization in 3 cases, resection of extrahepatic duct and biliary-enteric Roux-en-Y anastomosis in 14 cases, tumor resection and revascularization of hepatic portal bile duct in 1 case, palliative external drainage of intrahepatic bile duct in 5 cases, and Y-internal drainage of hepatic portal in 10 cases. In 10 patients with gallbladder carcinoma, resection of extrahepatic duct and gallbladder and biliaryenteric Roux-en-Y anastomosis in 2 cases, cholecystectmy in 3 cases, cholecystectmy and external drainage of intrahepatic bile duct in 1 case, cholecystectmy and Y-internal drainage by suspension of hepatic portal in 4 cases. A patient with middle bile duct cancer received radical resection of cholangiocarcinoma and biliary-enteric Roux-en-Y anastomosis. Of 8 patients with distal bile duct cancer, Whipple procedure were performed. Of 58 patients, 2 cases converted to hand-assistant procedure (3.4%). For all patients, operation time was (6.18±1.71) h, blood loss was (116.66±56.06) ml, blood transfusion was (85.55±38.28) ml, ambulation time was (9.10±2.91) h, feeding time was (14.95±4.35) h, and hospital stay was (12.81±4.29) d. Postoperative complications occurred in 8 cases (13.8%), including bile leakage (3 cases), wound bleeding (1 case), pancreatoenteric anastomotic leakage (2 cases), pulmonary infection (1 case), and renal failure (1 case). Of these 8 cases, 6 cases recovered smoothly and 2 cases die of severe pulmonary infection and renal failure after conservative treatment (3 or 4 weeks), therefore, the mortality of patients was 3.4%. In 36 patients with hilar cholangiocarcinoma, 19 cases died (on 2 monthes 4 cases, on 6 monthes 5 cases, on 10 monthes 8 cases, and on 12 monthes 2 cases after operation), 11 cases survival well (gt;26 monthes 4 cases, gt;22 monthes 3 cases, and gt;19 monthes 4 cases), and 6 cases required hospitalization. Of 10 patients with gallbladder carcinoma, 7 cases died (on 3 monthes 1 case, on 5 monthes 1 case, on 8 monthes 1 case, on 11 monthes 3 cases, and on 12 monthes 1 case after operation) and 3 cases survival (gt;17 monthes 2 cases, gt;13 monthes 1 case). In 8 cases undergoing pancreatoduodenectomy, 5 cases died (on 4 monthes 2 cases, on 6 monthes 2 cases, and 10 monthes 1 case after operation) and 3 cases survived well over 2 years. Three patients with intrahepatic bile duct cystadenocarcinoma survived over 1 year. Conclusionsda Vinci surgical system can carry out all kinds of surgery for biliary malignant tumor, especially prominent in the complicated surgeries for hepatic portal, which breaks through the restricted area of laparoscope in hepatobiliary malignant tumor.