| セッション情報 | シンポジウム13(消化器外科学会)肝胆膵外科領域におけるロボット・腹腔鏡下手術の現状と課題 |
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| タイトル | S13-基調講演2：Current limitations and future perspectives of robotic and laparoscopic surgeries in hepato-biliary-pancreatic diseases. |
| 演者 | M. L. Kendrick（Mayo Clinic） |
| 共同演者 | |
| 抄録 | Minimally invasive approaches are increasingly applied in hepatobiliary and pancreatic (HPB) surgery. A growing body of literature demonstrating favorable outcomes over open approaches has fueled this expansion. As for any new approach, initial limitations are eventually overcome as surgeon experience increases and the validity of the approach is assured. Each procedure will go through this process as a necessary transition to assure optimal patient safety and outcomes. Minimally invasive hepatectomy is currently supported by large comparative trials and several meta analysis. Nearly the entire spectrum of hepatic resectional procedures has been described utilizing a laparoscopic approach. Favorable outcomes are seen in even the most complex of diseases and procedures such as cirrhosis and major hepatectomy with biliary reconstruction. Application of MIS approaches to pancreatic surgery has seen less enthusiasm until more recently. Distal pancreatectomy is now widely accepted and is offered at most specialized centers. In centers with a large experience, there are few if any limitations, including patients with malignancy or requiring adjacent organ resection. Pancreaticoduodenectomy is still under some scrutiny as few centers have sufficient experience to validate the feasibility and outcomes. The past few years however, has seen a surge of interest and several centers are exploring this technique. Limitations in the early experience include avoidance of major venous resection and patients with significant prior surgical history. In a few centers, substantial experience with MIS pancreaticoduodenectomy has progressed to the ability to perform major venous resection and few if any limitations exist. Robotic assisted approaches are also of increasing interest. Touted advantages of 3-D visualization, added maneuverability and stable platform are difficult to measure with regard to patient outcomes. Currently there is no evidence that robotic assistance improves outcomes over laparoscopic approaches in equally trained surgeons. Disadvantages including lack of haptic feedback and added costs are important and rarely discussed. Robotic assistance avoids the need for advanced laparoscopic skills and it is possible the sole objective advantage is to expedite training in advanced MIS procedures. The future of MIS hepatobiliary and pancreatic surgery is bright. Improved patient outcomes are the expectation with regard to shorter, less complicated recovery. This may lead to improved quality of life and increased ability to receive adjuvant treatments when necessary. |
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