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강창무,김지수,최문석,황혜성,이우정 연세대학교의과대학 2024 Yonsei medical journal Vol.65 No.3
Purpose: Numerous robot-assisted pancreatic surgery are being performed worldwide. This study aimed to evaluate the feasibili ty and safety of the Revo-i robot system (Meerecompany, Seoul, Republic of Korea) for advanced pancreatic surgery, and also compare this new system with the existing da VinciTM robot system (Intuitive Surgical, Sunnyvale, CA, USA) in the context of ro bot-assisted pancreaticoduodenectomy (RPD). Materials and Methods: This study was a one-armed prospective clinical trial that assessed the Revo-i robot system for advanced pancreatic surgery. Ten patients aged 30 to 73 years were enrolled between December 2019 and August 2020. Postoperative out comes were retrospectively compared with those of the da VinciTM surgical system. From March 2017 to August 2020, a total of 47 patients who underwent RPD were analyzed retrospectively. Results: In the prospective clinical trial, pancreaticoduodenectomy was performed in nine patients and one patient underwent central pancreatectomy. Among the 10 study participants, the incidence of major complications was 0% in hospital stay. There were eight postoperative pancreatic fistula (POPF) biochemical leaks (80%). In the retrospective analysis that compared the Revo-i and da VinciTM robotic systems, 10 patients underwent Revo-i RPD and 37 patients underwent da VinciTM RPD, with no significant differences in complication or POPF incidence rates between the two groups (p=0.695, p=0.317). Conclusion: In this single-arm prospective study with short-term follow-up at a single institution, the Revo-i robotic surgical sys tem was safe and effective for advanced pancreatic surgery. Revo-i RPD is comparable to the da VinciTM RPD and is expected to have wide clinical application.
Minimally Invasive (Laparoscopic or Robotic) Reduced Port (Single Port) Distal Pancreatectomy
강창무 대한내시경복강경외과학회 2017 Journal of Minimally Invasive Surgery Vol.20 No.1
In spite of lack of randomized control study, laparoscopic distal pancreatectomy (DP) is regarded as appropriate treatment in managing benign and low grade malignant tumor in distal part of the pancreas. With the advance of laparoscopic skills, innovative instruments, and perioperative management, clinical effort to reduce the access injury for laparoscopic DP has been attempted to enhance the cosmetic effect and the benefit of minimally invasive surgery. Due to inborn technical limitation of laparoscopic surgical system, it is not easy to perform laparoscopic reduced port-or single port-distal pancreatectomy (LRP/LSP-DP) in daily routine clinical practice, however, surgical technique for safe and effective LRP/LSP-DP has been developed. Till now, only a few experts reported the technical feasibility and safety of LRP/LSP-DP in selected patients. According to literature review, the number of the patients who underwent LRP/LSP-DP seems to gradually increase. In this moment, surgical experiences may be too limited to reach the conclusion, but, with the help of robotic surgical system, LRP/LSP-DP has potential room for further investigation. Therefore, minimally invasive surgeons need to pay attention to this innovative movement. In this review, currently available surgical techniques for LRP/LSP-DP has been summarized with some future perspectives on this technique.
Surgical Experiences of Functioning Neuroendocrine Neoplasm of the Pancreas
강창무,박세호,김경식,최진섭,이우정,김병로 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.6
We present our surgical experiences with functioning neuroendocrine neoplasms of the pancreas to define its natural history, and to suggest its proper management. From June 1990 to June 2005, patients with diagnosis of functioning neuroendocrine (islet cell) neoplasms of the pancreas were retrospectively reviewed. Fourteen patients (5 men and 9 women) with a median age of 49 years (range, 12 - 68 years) were identified. Twelve patients (86%) had insulinoma, two (14%) had gastrinoma. One (7%) with pancreatic insulinoma was multiple endocrine neoplasia type 1. Intraoperative ultrasound scan (sensitivity, 83%) was the most powerful modality for tumor localization. Fifteen neoplasms with median tumor size 1 cm (range 0-3 cm) were resected. Four insulinomas (26.7%) were located in the head of the pancreas and 5 (36%), in the tail. Another 5 (36%) insulinomas and 1 (7%) gastrinoma were located around the neck area near the SMV or PV. Eleven patients (79%) underwent enucleation, and 2 patients (14%), distal pancreatectomy with splenectomy. 100% of patients with functioning neuroendocrine neoplasms of the pancreas have survived. The overall disease free 10-year survival was found to be about 81%. Exact localization of tumor by intraoperative ultrasound and surgical removal are promising for good prognosis.