2007 년도대한췌담도학회추계학술대회 Session IV: Recent Updates in Pancreatobiliary Diseases Laparoscopic & Robotic Surgery in Pancreas Disease Department of Surgery, Yonsei University College of Medicine, Korea Woo-Jung Lee Laparoscopic Approach PAST Diagnostic tool Pancreatic cancer RECENT Indication Pancreatic pseudocyst Benign solid tumor Cystic lesion Low-grade malignancy 209
20 2007 년도대한췌담도학회추계학술대회 Common procedures in Hepato-Biliary Biliary-Pancreatic surgery Cholecystectomy (gallbladder stone & cholecystitis) Common bile duct stone & IHD stone disease Diagnostic laparoscopy in HBP disease Bilio-enteric & Gastro-jejunostomy Malignant gallbladder disease Liver cyst Benign liver tumor resection & liver resection Malignant liver tumor resection Radio-Frequency Ablation & Cryosurgery for liver tumors Splenectomy Adrenalectomy Acute & chronic pancreatitis Pancreatic tumors (cystic & solid tumors) Thoracoscopic splanchnicectomy for intractable abdominal pain
Woo-Jung Lee:Laparoscopic & Robotic Surgery in Pancreas Disease 2 Background We reviewed our preliminary experiences and results of laparoscopic surgery in pancreatic disorder With the aim of assessing the safety and feasibility of such procedures Materials & Methods Observed periods: Laparoscopic surgery 26 cases st January, 2004 ~ 3 th July, 2007 Study group Objective group : Laparoscopic surgery 26 patients (davinci( Robot surgery case) Control group : Open Surgery for SPN 22 patients Review General characteristics Surgical outcomes
22 2007 년도대한췌담도학회추계학술대회 Results (I) - General Characteristics mean (range), frequency Age (years) 46.5 (25-76) Gender Male Female 8 8 Symptoms Incidental Detection Abdominal discomfort Neuroglycopenic 6 7 3 Results (II) - Tumor Location & Surgery type Distal Pancreatectomy : 7 cases Head Body Tail : 4 cases : cases : cases Enucleation : 9 cases
Woo-Jung Lee:Laparoscopic & Robotic Surgery in Pancreas Disease 23 Tumor size (mean, cm) Pathology Results (III) - Pathologic Characteristics Lymphoepithelial cyst Mucinous cystic tumor Serous cystic tumor Solid pseudopapillary neoplasm IPMT Benign stricture duct d/t pancreatitis Pseudocyst Non-functioning endocrine tumor Insulinoma Ductal adenocarinoma Mean (range), frequency 3. (0.9-7.5) 2 3 6 5 2 2 2 No pathologic diagnosis ( insulinoma?) Surgery Type Results (IV) Enucleation Distal pancreatectomy Spleen preserving - Surgical Outcomes Mean (range), frequency 9 7 4 Laparoscopic adrenalectomy Operation Time (min.) Bleeding (ml) Transfusion Complication Mortality 252 (0-565) 5 (trivial( trivial-500) None 9 None
24 2007 년도대한췌담도학회추계학술대회 Results (V) - Complications Mean (range), frequency Mortality Variety Pancreatic leak Fluid collection around surgical site Herniation through Mesenteric Defect None 4 3 Abdominal abscess Results (VI) - Open vs. Laparoscopic Surgery Gender Age Tumor size Operation Type Operation time Bleeding Diet start Hospital stay Complication Male : Female Distal pancreatectomy Enucleation Yes / No Open 4 : 8 30.2 ±0.2 6. ±3.6 7 5 66.0 ±4.2 585.0 ±364. 6.5 ±3.7 3.6 ±9.6 6 / 6 Lapa 8 : 8 46.5 ±5.8 3. ±.6 8 8 252.2 ±39.2 5.4 ±83.8.7 ±0.9 9.4 ±4.8 9 / 7 P-value NS < 0.00 0.00 NS 0.006 0.002 0.00 0.055 NS
Woo-Jung Lee:Laparoscopic & Robotic Surgery in Pancreas Disease 25 Case. Laparoscopic Left adrenalectomy due to adrenal gland tumor (Cushing) & Excision of cystic tumor (mucinous tumor )of pancreatic body
26 2007 년도대한췌담도학회추계학술대회 A K A P C C A C A C Case 2. Laparoscopic Distal pancreatectomy & splenectomy due to pancreatic body cystic tumor (serous cystadenoma)
Woo-Jung Lee Laparoscopic & Robotic Surgery in Pancreas Disease 27
28 2007년도 대한췌담도학회 추계학술대회 C P S P P P S da Vinci system
Woo-Jung Lee:Laparoscopic & Robotic Surgery in Pancreas Disease 29 Master-slave manipulator da Vinci TM (Intuitive Surgical Inc., CA, USA) 2005.7.5. First Robotic Surgery(Cholecystectomy) in Korea using da Vinci YUMC Endoscopic / Robotic Surgery Center Severance experience of da Vinci System From July 5th, 2005 July 3, 2007 400 da Vinci Tele-operative Surgery 2 Cholecystectomy 4 Choledochal cyst operation Pancreatic cystic tumor excision Lt. Lateral segmentectomy of liver(hcc) 39 Rectal & Sigmoid colon cancer 3 Mediastinal tumor excision 0 Esophageal surgery 6 Heart surgery (2 ASD & 4 MR) 204 Prostatectomy (Prostate cancer) 87 Gastrectomy (Stomach cancer) 28 Gynecologic surgery(tah)
220 2007 년도대한췌담도학회추계학술대회 Conclusion Result Feasible & Safe More Cosmetic & Less Pain Demand More Experience in Surgery Long Term Follow-up Proposal Practice for Excellence in Skill Robot-assisted : fine movement & 3-D image