机器人胰十二指肠切除术

解剖胰颈下缘肠系膜上静脉，离断胃结肠干，游离十二指肠及胰头，解剖下腔静脉、左肾静脉、肠系膜上动脉并清扫淋巴结。离断空肠、胰十二指肠下动静脉及钩突；解剖变异肝总动脉(起源于肠系膜上动脉)。解剖胰颈上缘门静脉及胆管、离断胃右和胃十二指肠动脉并清扫淋巴结；离断远端胃、胰颈、胆管、切除胆囊。消化道重建：胰管内置硅胶管行内引流；4－0普理灵缝扎胰腺断端，4－0普理灵连续缝合胰腺断端与空肠浆肌层。4－0普理灵行胆肠吻合。胃后壁与空肠用3－0普理灵行连续侧侧吻合。文氏孔及胰肠吻合前置引流管。病理：中分化腺癌，T₂N₁M₀。

Robotic pancreaticoduodenectomy

After the SMV was identified at the inferior border of the pancreas, the gastrocolic trunk was divided, then duodenum and pancreatic head were mobilized, inferior vena cava, left renal vein and SMA were dissected and lymphadenectomy was performed respectively. The proximal jejunum was transected by using a stapler and IPDA was clipped and divided. Afterward, the pancreatic head was isolated from the PV/SMV and the posterior-superior pancreaticoduodenal veins were divided on the right side of the SMA. Additionally, the common hepatic artery originates from superior mesenteric artery was explored. After transected distal stomach by using a stapler, the right gastric artery and the gastric duodenal artery were identified and divided, then the portal vein was exposed. Subsequently, the pancreatic neck was transected, the common bile duct was exposed and taped. After the gallbladder was removed, the bile duct was dissected. After resection, a conventional loop reconstruction was performed including an end-to-side pancreaticojejunostomy with modified duct-to-mucosa technique and single-layer continuous suture with 4-0 Prolene. Subsequently, the end-to-side running suture hepaticojejunostomy with 4-0 Proleneand side-to-side gastrojejunostomy with 3-0 Prolene. Pathology confirmed R0 resection for a moderately differentiated adenocarcinoma graded pT₂N₁M₀.