소아 담관낭종의 로봇수술의 초기경험
Trocars for robotic arms Trocar for laparoscopic assist
Fig. 1. The 12-mm camera port was inserted at supraumbilical area. Two 8-mm working ports were selected based on the size of patients and the location of cyst under viewing of the peritoneal cavity. An accessory 10-mm laparoscopic port was placed to assist inserting suture-materials, cutting the sutures, retracting organs, and providing suction or irrigation as required.
Fig. 2. Three-dimensional image of hepaticojejunostomy using robotic arms with 5-0 Vicryl interrupted sutures after resection of choledochal cyst.
Table 1. Summary of the Patients Treated by Robotic-assisted Resection of Choledochal Cyst.
Case Age
(y)
Wt
(kg) Type Op. time
(h) Morbidity Postop.
stay (d)
Follow-up (m)
1 2.8 11.7 c 10.2 Lapa. 9 35
2 14.8 39.1 c 13.6 St. 8 34
3 4.4 17.3 c 10.5 Leak. 18 10
4 3.2 15.6 c 11.6 No 8 6
5 2.3 12.0 a 9.9 No 9 3
6 10.8 40 c
+FNH 11.1 No 9 1
Mean±SD 6.4 ± 5.2 22.6 ± 13.3 11.2 ± 1.3 10.2 ± 3.9 14.8 ± 15.5 Type: Todani’s classification of choledochal cyst, Lapa.; Laparotomy, St.; stenosis of hepaticojejunostomy, Leak.; leakage of hepaticojejunostomy, FNH; focal nodular hyperplasia, SD; standard deviation
Table 2. English Literatures Review of Robotic-assisted Resection of Choledochal Cyst in Children.
Year Case
no. Age (yr) Wt. (kg) Op. time (hr)
J-J stomy
R-Y
Limb Morbidity Postop.
Stay (d)
2011p 6 6.2m 22.6m 11.4m Intra.
àExtra. Ante.
Lapa. (1) St. (1) Leak. (1)
10m
201016 1 14 NA 3 Extra. Ante. Leak. 28
20106 5 1m 8.5m 8m Extra. Retro. No 6m
20105 3 NA NA NA NA NA Lapa. (2) NA
20074 2 NA NA 7.1 Intra. NA No 4
20072 1 NA NA NA Extra. NA No NA
20063 1 5 22 7.3 Extra. Ante. No 4
P; Present series, Lapa.; Laparotomy , St.; Stenosis of hepaticojejunostomy, Leak.; Leakage of hepaticojejunostomy, J-J stomy; Jejunojejunostomy, m; Mean or median, Extra.;
Extracorporeal method, Intra.; Intracoporeal method, Retro.; Retrocolic route, Ante.;
Antecolic route.
1. Farello GA, Cerofolini A, Rebonato M, Bergamaschi G, Ferrari C, Chiappetta A:
Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc 5:354-8, 1995
2. Klein MD, Langenburg SE, Kabeer M, Lorincz A, Knight CG: Pediatric robotic surgery: lessons from a clinical experience. J Laparoendosc Adv Surg Tech A 17:265-71, 2007
3. Woo R, Le D, Albanese CT, Kim SS:
Robot-assisted laparoscopic resection of a type I choledochal cyst in a child. J Laparoendosc Adv Surg Tech A 16:179-83, 2006
4. Meehan JJ, Elliott S, Sandler A: The robotic approach to complex hepatobiliary anomalies in children: preliminary report.
J Pediatr Surg 42:2110-4, 2007
5. Alqahtani A, Albassam A, Zamakhshary M, et al.: Robot-assisted pediatric surgery:
how far can we go? World J Surg 34:975-8, 2010
6. Dawrant MJ, Najmaldin AS, Alizai NK:
Robot-assisted resection of choledochal cysts and hepaticojejunostomy in children less than 10 kg. J Pediatr Surg 45:2364-8, 2010
7. Humphrey GM, Najmaldin A: Modi- fication of the Hasson technique in paediatric laparoscopy. Br J Surg 81:1319, 1994
8. Nguyen Thanh L, Hien PD, Dung le A,
Son TN: Laparoscopic repair for choledochal cyst: lessons learned from 190 cases. J Pediatr Surg 45:540-4, 2010 9. Venerito M, Fry LC, Rickes S,
Malfertheiner P, Monkemuller K:
Cholangitis as a late complication of choledochoduodenostomy: the sump syndrome. Endoscopy 2009;41 Suppl 2:E142-3
10. Rumans MC, Katon RM, Lowe DK:
Hepatic abscesses as a complication of the sump syndrome: combined surgical and endoscopic therapy. Case report and review of the literature. Gastroenterology 92:791-5, 1987
11. Maeda A, Yokoi S, Kunou T, et al.: Bile duct cancer developing 21 years after choledochoduodenostomy. Dig Surg 20:331-4, 2003
12. Hiura A, Kim EC, Ikehara T, Matsumura Y, Mishima K, Ishida I: Hepatic abscess as a complication of the sump syndrome.
J Hepatobiliary Pancreat Surg 7:231-5, 2000
13. Horgan S, Vanuno D: Robots in laparoscopic surgery. J Laparoendosc Adv Surg Tech A 11:415-9, 2001
14. Hazey JW, Melvin WS: Robot-assisted general surgery. Semin Laparosc Surg 11:107-12, 2004
15. Cadiere GB, Himpens J, Germay O, et al.: Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25:1467-77, 2001
16. Akaraviputh T, Trakarnsanga A, Suksamanapun N: Robot-assisted complete excision of choledochal cyst type I, hepaticojejunostomy and extracorporeal Roux-en-y anastomosis: a case report and review literature. World J Surg Oncol 8:87, 2010
