Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 679 - файл
.pdf
Robotic-assisted Partial
https://t.me/medicina_free
Splenectomy
ZhigangGao andYuebinZhang
14
14.1 Introduction
In recent years, with research progress on spleen
immune function, an increasing number of scholars have begun to pay attention to the immune
function of the spleen, especially in teenagers
and children, and the requirements for spleen
preserving surgery in the clinic are increasingly
high. Compared with total splenectomy, partial
splenectomy has the advantage of avoiding the
risk of infection and thrombosis after total splenectomy; and the disadvantage is increased risk
of perioperative bleeding. The anatomical operation of partial splenectomy is more complicated,
and intraoperative bleeding easily affects the
operation, so the technical and experience
requirements of the operator are higher.
Successful laparoscopic partial splenectomy
(LPS) was rst reported by Seshadri etal. in 2000
[1, 2]. As of December 2020, there were no reports
on robotic partial splenectomy (RPS) worldwide.
The splenic artery can be branched off into the
spleen step by step. According to the different anatomy of splenic artery branches, they can be divided
into centralized type and dispersed type. The concentrated type accounts for about 30% and is
divided into two branches at 0.6–2cm away from
the hilum of the spleen, namely the superior and
inferior terminal branches. The main trunk of this
type is relatively long, and the branches are relatively short. The dispersed type accounts for about
70%. The splenic artery divides into superior and
inferior splenic arteries and superior and inferior
splenic terminal arteries at 2.1–6.0 cm from the
hilum of the spleen. In this type, the main trunk is
relatively short and the branches are long. The
blood supply in the spleen is segmentally distributed by the splenic terminal artery with little cross
supply [3], which provides the anatomical basis for
partial splenectomy. With the continuous updates
and progress of medical instruments, the ability of
ne anatomy and wound hemostasis have been
greatly enhanced, which also provides technical
support for partial splenectomy [4].
14.2 Indications
andContraindications
Supplementary Information The online version contains supplementary material available at https://doi.org/
10.1007/978- 981- 19- 9693- 1_14.
Z. Gao (*) · Y. Zhang
Department of General Surgery, Children’s Hospital,
Zhejiang University School of Medicine, Hangzhou,
China
e-mail: ebwk@zju.edu.cn; pwzyb@zju.edu.cn
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
Q. Shu (ed.), Pediatric Robotic Surgery, https://doi.org/10.1007/978-981-19-9693-1_14
With the continuous improvement of minimally
invasive technology and the application of
advanced equipment and instruments,
robot- assisted surgery systems can provide a better eld of vision than traditional laparoscopy,
more detailed anatomical operations, and avoid
or reduce the probability of conversion to open
surgery caused by massive bleeding.
95
96
https://t.me/medicina_free
Z. Gao and Y. Zhang
14.2.1 Indications
Partial splenectomy is suitable for local benign
tumors of the spleen, especially in cases where
the tumor is located at the upper or lower pole of
the spleen [2–4].
14.2.2 Contraindications
(a) Poor general condition, poor function of
heart and lung and other important organs,
intolerant to pneumoperitoneum.
(b) Hematological or other systemic diseases
requiring total splenectomy.
(c) A history of severe abdominal trauma or sur-
gery with serious adhesion in the surgical
area.
(d) Severe splenic trauma or splenic laceration,
with large blood loss and unstable vital signs.
14.3 Preoperative Preparation
In addition to the routine understanding of the
patient’s general condition, the size of the spleen,
and the relationship between the location of the
tumor and pancreas, routine enhanced CT examination is also required to understand the course of
the splenic blood vessels, the location of the
tumor in the spleen and its corresponding supplying blood vessels. A detailed plan was made to
determine the extent of the tumor resection and
the preservation of the upper or lower pole of the
spleen.
1. Compared with total splenectomy, partial splenectomy has restrictions on the age of the
patients, but the operation is more difcult and
the risk of bleeding is higher. Therefore, a
comprehensive evaluation of the patients’ general conditions and their tolerance to the operation should be conducted before surgery.
2. Perfect preoperative imaging examination:
ultrasound and enhanced CT examination
were performed to understand the size of the
spleen, the position of the splenic mass in the
spleen and the range of the spleen to be
removed. Individual surgical plans were formulated to fully evaluate the possible risks
and take appropriate emergency measures.
3. Preoperative nutritional support to correct
malnutrition. Severe anemia can be corrected
by blood transfusion before surgery.
4. Routine preoperative preparation: preoperative fasting of semi-uid for 6hours, preoperative water fornication for 2 hours, skin
preparation, gastrointestinal decompression,
catheterization, preoperative sterilization,
blood preparation, and correction of severe
anemia and water and electrolyte disorders.
5. Surgical instruments: Select the matching
operating instruments according to the size of
the child, and routinely provide ultrasonic
knife or LigaSure. Due to the risk of massive
intraoperative bleeding, an autologous blood
transfusion device is recommended in qualied
units.
14.4 Position andDocking
1. Surgical position
In the supine position, the head is tilted 30°
high and the feet are tilted 30–45° to the right
side to facilitate the exposure of the operative
eld [5].
2. Layout of the operation hole (Fig.14.1)
(a) The observation hole (No. 2 arm) is
located in the umbilical cord. If the giant
spleen crosses the mid-umbilical line, the
puncture hole can be appropriately moved
to the right;
(b) Operating hole 1 (No. 1 arm) between the
midline of the clavicle of the right upper
abdomen and the linea alba (adjusted
according to the size of the child and the
condition of the spleen);
(c) Operating hole 2 (No. 3 arm) left abdomi-
nal axillary front horizontal;
(d) The auxiliary operation hole (assistant
hole) is located behind the midpoint of
the connection between the observation
hole and operation hole 2;
14 Robotic-assisted Partial Splenectomy
https://t.me/medicina_free
Fig. 14.1 Position of the Troca
(e) The spare operation hole (No. 4 arm) can
be used if the operation is difcult
because it is not used routinely. Generally,
the spare operation hole can be located
under the xiphoid process or at the level
of the midline of the left abdominal
axillary;
14.5 Surgical Procedures
1. The surgical position
The selection of trocar was prepared
puncture points should be adjusted according
to the position and size of the spleen. In principle, the distance between the operating
area and the trocar should be reasonable
(4–8cm), and it is advisable that each operating instrument should not interfere with
each other [6].
2. Routine disinfection towel laying, surgical
nurse to prepare the robot operating arm sterile bag.
97
3. Establishment of pneumoperitoneum and
placement of trocar: The center of umbilical
ring was cut 8mm longitudinally, and pneumoperitoneum was established by needle
puncture (pressure 6–12mmHg) or the rst
8mm trocar was placed through the primary
endoscope under direct vision. The second
8mm cannula was placed at the front of the
left abdominal axillary line, and its position
was positioned according to the lower position of the spleen. The operation distance was
sufcient, and it was used as the main operation hole for inserting ultrasonic knife, bipolar
electrocoagulation, electrocoagulation hook
or needle holder, etc. A third 8mm cannula
was placed in the right middle and upper
abdomen, and a dissector or operating forceps
was inserted. A fourth 5 mm cannula was
placed behind the midpoint of the connection
between the umbilical primary mirror and the
left ventral operating hole to serve as an auxiliary operating hole for operations such as
traction exposure, attraction, ultrasonic knife,
hemo-lock, needle, and thread entry and exit.
4. Spleen management: The surgical plan was
determined according to the location and
range of the spleen to be removed.
Subtotal splenectomy is the removal of
70–80% of the spleen and the retention of
20–30%. The upper pole vessels of spleen can
be preserved by short gastric vessels and
spleen-stomach ligaments. Alternatively the
blood supply of the residual spleen in the
lower pole of the spleen can be preserved by
using the splenic omentum vessels, and the
spleen- colon ligament (Fig.14.2a).
Superior pole splenectomy is used to
remove benign masses localized to the upper
pole of the spleen, preserving the lower part
and middle part of the spleen. The short gastric vessels and the ligaments of the spleen
and stomach should be dissected to expose the
splenic artery of the splenic secondary vessels. When the branches of the splenic artery
are concentrated, the splenic artery of the
splenic pole should be attached to the spleen.
Ligation should be performed particularly for
avoiding bleeding. After ligation of the short
98
ab
cd
https://t.me/medicina_free
Z. Gao and Y. Zhang
Fig. 14.2 (a) Preserving the lower pole of the spleen; (b) Ligation of the splenic superior pole artery; (c) The ischemic
line of the upper pole of the spleen; (d) The splenic mass was resected within the ischemia line
gastric vessel and the superior splenic pole
artery (Fig.14.2b), an obvious ischemia dividing line (Fig. 14.2c) can be observed at the
upper splenic pole. Within the 0.5cm-1cm
of the ischemia dividing line, an electrocoagulation hook or ultrasonic knife was used to
remove the dividing line (Fig.14.2d), and the
section should be accurately hemostatic.
Splenectomy is mainly used to remove
benign masses conned to the lower part of
the spleen, preserving the upper pole and middle part of the spleen. The spleen-colonic ligament, spleen-renal ligament, splenic omentum
vessels, and splenic inferior artery (secondary
splenic vessels) should be dissected, and the
splenic inferior pole should be resected within
the ischemic boundary after the ischemia
band appears in the splenic inferior pole.
Surgical selection should be particularly
careful when the splenic mass is located in the
middle of the spleen near the hilum. Resection
of a mass near the hilar of the spleen is not the
best indication for laparoscopic or robotic partial splenectomy. There is a rich vascular network near the hilum of the spleen, and it is
difcult to separate the secondary vessels of
the spleen. In the process of splenectomy in
the middle of the spleen, there is often more
bleeding. When hemostasis is difcult, total
splenectomy or open surgery should be performed. If the splenic mass is located in the
medial lateral part of the spleen or far from the
hilum of the spleen, the surgical method of
mass exhumation can be adopted. During the
operation, close attention should be paid to the
bleeding situation, which is difcult and risky.
14 Robotic-assisted Partial Splenectomy
https://t.me/medicina_free
99
6. The spleen removed the lens from the left side
of the abdomen (operating hole 2) into, out
time for 8mm casing, improvement to offer
12mm casing to put content bag is opened,
the spleen into, and then closed mouth and
pulled out a 12mm casing expand poke holes,
pull out the fetch mouth, spleen removed with
egg circle clamp or scissors to cut up, pay
attention to avoid any damage to fetch the bag
the spleen tissue left abdomen.
7. The abdominal cavity was explored by placing the umbilical cord with discontinuous
suture of absorbable thread for drainage to
make the splenic incision, reconstruct the
pneumoperitoneum, and ush the spleen bed
and the residual splenic section to investigate
whether there is active bleeding. A routine
drainage tube was placed in the splenic fossa,
the lens was removed, and the incision was
sutured.
14.6 Technical Points andSkills
reduce the risk of massive bleeding. During
splenectomy, attention should be given to preserving the short gastric vessels and the ligaments of the spleen and stomach to prevent
ischemia or torsion of the upper pole of the
spleen. During the resection of the upper pole
of the spleen, attention should be paid to preserving the splenic omentum vessels and the
spleen-colon ligament to prevent the ischemia
or torsion of the lower pole of the spleen.
When it is difcult to expose the anatomy of
the upper pole of the spleen, a traction wire
can be applied to pull the stomach to the right
to expose the visual eld.
3. Dual ligation of silk thread and hemo-lock is
more reliable for the ligation of splenic vessels. Robotic instruments lack force feedback,
so grip strength must be controlled during the
anatomy of the splenic hilar vessels to avoid
blood vessel tearing and bleeding. After the
operation, drainage of the splenic fossa is
helpful to observe postoperative bleeding.
1. Because of the operation of the upper abdomen, the distal side of the manipulator arm is
prone to downward pressure. However, due to
the remote control of the master, in the
absence of force feedback, the manipulator
arm may compress the patient's leg and cause
injury while the master is unaware of the serious consequences. Therefore, the body position should be taken with the head high foot
low position, cephalic elevation of about
15–30°, and right side tilt of 10–15°. Adequate
movement space was given to the robotic arm
during operation. The location of the puncture
operation hole should be adjusted according
to the size of the spleen [7]. In principle, the
location of the operation hole should be more
than 2 cm from the edge of the spleen and
more than 4 cm from the operation area to
avoid the limitation of the movement of the
manipulator arm.
2. When the splenic mass to be resected is
located in the middle of the spleen, the risk of
intraoperative bleeding is increased, and preocclusion of the splenic artery is feasible to
14.7 Postoperative Complications
1. Postoperative bleeding usually occurs within
24hours after surgery [8, 9], and the common
causes are ligation of vascular line knots or
coagulation resection of vessel eschar shedding and bleeding, even bleeding on the
wound surface. When treating the spleen pedicle, loose or unstable ligation and retraction
of blood vessels may cause massive bleeding.
In particular, preoperative blood diseases with
coagulation mechanism disorders should be
corrected, and intraoperative blood vessels
should be carefully handled. The wound
should be carefully examined for active bleeding before the end of the operation. Attention
should be given the spleen bed drainage tube
small blood loss can be follow-up observed,
quickly replenishing the blood volume, hemostasis; If the amount of bleeding is large, rapid
surgical exploration should be performed to
clear the bleeding area, and ligation or suturing should be performed at the active bleeding
site to stop the bleeding.
100
https://t.me/medicina_free
Z. Gao and Y. Zhang
2. The incidence of pancreatic stula after splenectomy is 3–5%. The Amylase test can be
used to identify the drainage uid. The cause
of postoperative pancreatic stula is closely
related to the spleen, and the pancreatic tail
is injured during the intraoperative treatment
of the splenic pedicle or the application of
the straight-cut closure device, resulting in
postoperative pancreatic stula. It is very
important to maintain smooth drainage for
the management of postoperative pancreatic
stula. In addition, inhibition of trypsin
secretion, anti-inammation, maintenance of
water and electrolyte balance, and systemic
nutritional support can mostly be conservatively improved. If there is no improvement
or deterioration of the condition, surgery can
be performed. The prevention measures of
pancreatic stula should be a gentle operation during the operation, familiarity with
the anatomy, avoidance of large ligation at
the tail of the pancreas, and adoption of the
treatment method of secondary splenic pedicle to reduce the injury of the tail of the
pancreas.
3. Tumor recurrence: There is a certain recurrence rate after splenic mass resection, and the
level of recurrence rate is related to the integrity of the resection. It has been reported in
the literature that the recurrence rate after
splenectomy or partial resection of the splenic
mass is signicantly lower than that after windowing of the splenic mass (cyst). Extended
partial resection is an effective mean to reduce
the recurrence rate.
4. Residual abdominal infection of the left
subphrenic abscess is the most common,
mainly in subphrenic blood and uid secondary infection, improper treatment of
pancreatic tail injury, gastric or colon collateral injury pollution, patients with low
immunity, etc. Postoperative persistent high
fever and symptoms of diaphragmatic stimulation should be taken into account, and
further X-ray examination should be conducted to show left diaphragmatic elevation
and movement limitation. Ultrasound or CT
could nd subdiaphragmatic uid inclusion.
After diagnosis, active anti-infection and
supportive treatment should be performed.
If the conservative effect is not good, puncture or incision drainage should be performed in time. It is very important to
maintain the patency of postoperative drainage by careful operation, avoiding contamination and placing subphrenic drainage
tubes after operation.
5. Portal vein thrombosis (PVT) is a potentially
life-threatening complication that can occur
days to months after surgery. Postoperative
portal vein thrombosis may be related to multiple factors such as vascular endothelial
injury, local eddy current formed by slow portal vein blood ow velocity, and platelet
increase. The clinical manifestations of PVT
are usually atypical and may include diffuse
abdominal pain, fever, nausea, diarrhea, loss
of appetite, or other symptoms. In patients
with nonspecic abdominal symptoms, PVT
must be considered and examined early. PVT
should be treated with intravenous low molecular weight heparin and later oral warfarin as
soon as diagnosed. The current standard of
warfarin treatment aims to maintain the internationally standardized rate of 3–6 months
(INR between 1.5 and 2.0).
6. Incisional hernias tend to occur at umbilical
incisions, where the spleen is prolonged and
removed through the umbilical incision. The
size of the umbilical incision is usually
15–25 mm. In general, the puncture site is
larger than 5mm and the whole suture process
is recommended to close the abdominal wall
defect to reduce the risk of incision, dehiscence, or incisional hernia.
7. Intravenous obstruction: There is a risk of
adhesive ileus after any abdominal surgery.
Accurately performing the surgical process to
minimize side injuries is crucial for reducing
the incidence of postoperative adhesions.
Anti- adhesion products can also be used prophylactically. Finally, during the process of
closing the peritoneal membrane, accidental
suturing of the omentum or intestinal canal
causing iatrogenic adhesive intestinal obstruction should be avoided.
14 Robotic-assisted Partial Splenectomy
https://t.me/medicina_free
101
14.8 Comparisons
withConventional
Laparoscopic Surgery
Robotic partial splenectomy (RPS) is essentially
laparoscopic partial splenectomy (LPS) with
upgraded instruments and equipment [10]. The
operation relies on the visual eld provided by
the primary view scope. If the visual eld is contaminated or massive bleeding cannot expose the
operating eld, it cannot replace open surgery.
RPS has many advantages over LPS, but there are
also some disadvantages.
14.8.1 Advantages
1. The three-dimensional vision of RPS is
clearer than that of LPS [11, 12].As a thermal
light source, the lens clarity can be maintained
for a long time without being affected by
smoke, which guarantees a for smooth surgical process.
2. The highly exible robotic arm system of RPS
can complete difcult operations such as grasping, holding, crossing, hemostasis, and ligation
in a narrow space, which suturing cannot be
achieved by LPS and human hands [13, 14]. At
the same time, it reduces the sense of fatigue of
the surgeon and reduces, the misoperation.
3. The learning curve of robot system for dif-
cult surgery is signicantly the lower than that
of traditional laparoscopy, and doctors with
certain experience in laparoscopic surgery can
quickly adapt to surgical operations.
14.8.2 Limitations
1. The robotic arm of the robot system will
occupy a certain space, and the selection and
operation space of the assistant auxiliary hole
will be more limited than that of the traditional laparoscope [15].
2. The operation cost of the robot system and the
use of instruments are higher than those of
traditional laparoscopy. The conversion prob-
ability of partial splenectomy is higher than
that of total splenectomy, which will increase
the medical cost.
References
1. Balaphas A, Buchs NC, Meyer J, etal. Partial splenectomy in the era of minimally invasive surgery: the
current laparoscopic and robotic experiences. Surg
Endosc. 2015;29:3618–27.
2. Vasilescu C, Tudor S, Popa M, Tiron A, Lupescu
I. Robotic partial splenectomy for hydatid cyst of
the spleen. Langenbeck’s Arch Surg. 2010;395:
1169–74.
3. Wiwanitkit V. Partial robotic splenectomy in hydatid
disease. Langenbeck’s Arch Surg. 2019:5.
4. Kirih MA, Liang X, Xie Y, etal. Robot-assisted partial splenectomy for splenic epidermoid cyst. Case
Rep Surg. 2020;2020:6245909.
5. Royall NA, Walsh RM. Robotic distal pancreatectomy and splenectomy: rationale and technical considerations. J Visual Surg. 2017;3:135.
6. Kashi PK, Rojas C, Casablanca Y, et al. A sevenstep surgical strategy for robotic splenectomy. Int
J Gynecol Cancer. 2020;30:1079–80. https://doi.
org/10.1136/ijgc- 2020- 001259.
7. Di Franco G, Gianardi D, Bianchini M, et al. The
role of hand-assisted laparoscopic splenectomy
for mega spleens in the da Vinci era. J Robot Surg.
2019;13:791–2.
8. Aziret M, Koyun B, Karaman K, etal. Intraoperative
hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy.
Turk J Surg. 2020;18:72–81.
9. Peng F, Lai L, Luo M, et al. Comparison of early
postoperative results between robot-assisted and
laparoscopic splenectomy for non-traumatic splenic
diseases rather than portal hypertensive hypersplenism-a meta-analysis. Asian J Surg. 2020;43:
36–43.
10. Manciu S, Nae GA, Diaconu A, et al. Long-term
evaluation of the outcomes of subtotal laparoscopic
and robotic splenectomy in hereditary spherocytosis.
World J Surg. 2020;44:2220–8.
11. Davide C, Solaini L, Di Pietrantonio D, etal. Robotic
vs laparoscopic splenectomy for splenomegaly: a
retrospective comparative cohort study. Int J Surg.
2018;55:1–4.
12. Shelby R, Kulaylat AN, Villella A, etal. A comparison of robotic-assisted splenectomy and laparoscopic
splenectomy for children with hematologic disorders.
J Pediatr Surg. 2021;56:1047–50.
13. Bhattacharya P, Phelan L, Fisher S, et al. Robotic
vs. laparoscopic splenectomy in Management
102
https://t.me/medicina_free
Z. Gao and Y. Zhang
of non- traumatic Splenic Pathologies: a systematic review and meta-analysis. Am Surg. 2021;
17:38–47.
14. Cavaliere D, Solaini L, Di Pietrantonio D, et al.
Robotic vs laparoscopic splenectomy for spleno-
megaly: a retrospective comparative cohort study. Int
J Surg. 2018;55:1–4.
15. Parsi S, Siripurapu V. Robotic-assisted splenectomy
for massive splenomegaly secondary to sarcoidosis.
Am Surg. 2018;84:e201–3.
Robotic-Assisted Mesenteric Cyst
https://t.me/medicina_free
Resection
ZhigangGao andDiHu
15.1 Introduction
A mesenteric cyst is a cystic mass that develops
in the abdomen due to congenital lymphangiodysplasia [1]. It is a rare condition that accounts
for about 1in 20,000 hospitalized children and is
more commonly seen in children between the
ages of 2 and 10 years. The rst report of mesenteric cysts was in 1507 by Benevenni, an Italian
anatomist, who found the abdominal mass during
an autopsy on an 8-year-old boy [2]. Mesenteric
cysts can occur in various locations throughout
the body, ranging from the mesentery of the duodenum to the sigmoid colon and even within the
retroperitoneum. Mesenteric cysts are commonly
found in the mesentery of the small bowel, especially in the ileum. Kurtz reported that in a series
of 162 patients, 60% of mesenteric cysts affected
the small bowel, 24% affected the mesentery of
the large bowel, and 14.5% were located in the
retroperitoneum at the base of the mesentery [3].
Supplementary Information The online version contains supplementary material available at https://doi.org/
10.1007/978- 981- 19- 9693- 1_15.
Z. Gao (*) · D. Hu
Department of General Surgery, Children’s Hospital,
Zhejiang University School of Medicine, Hangzhou,
China
e-mail: ebwk@zju.edu.cn
15
The presentation of mesenteric cysts can vary
widely, depending on their location, size, and
whether they compress other abdominal organs.
Symptoms are often nonspecic, mesenteric
cysts are typically diagnosed incidentally using
ultrasonography or CT scans [4].
The presence or absence of characteristic clinical presentations of mesenteric cysts is related to
their size. Symptoms are often not obvious and
nonspecic, but may include abdominal pain,
vomiting, constipation, and a palpable abdominal
mass [4]. Abdominal discomfort and pain are the
most frequently reported symptoms, accounting
for 80% of cases [4]. Mesenteric cysts can lead to
a variety of complications, including torsion,
rupture, hemorrhage, infection, and intestinal
obstruction [5]. The rst successful surgical treatment of a mesenteric cyst was performed by
Tillaux in 1880 [6]. In 1897, O’Conor described
a procedure in which the edges of a chylous mesenteric cyst were sutured to the skin to create a
marsupialized opening, after initially trying to
make an enucleation procedure but stopping due
to risk of hemorrhage [7]. Laparoscopic surgery
for mesenteric cysts was rst successfully
reported in 1993 by Mackenzie etal. [4] due to
the rarity of the condition. In cases whose cyst is
located near a major abdominal vessel, some surgeons have opted for laparotomic or laparoscopic
fenestration of the cyst.
In recent years, the utilization of laparoscopic
mesenteric cyst resection is gradually increasing,
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
Q. Shu (ed.), Pediatric Robotic Surgery, https://doi.org/10.1007/978-981-19-9693-1_15
103
104
https://t.me/medicina_free
Z. Gao and D. Hu
due to the advances in laparoscopy, resulting in
satisfactory treatment outcomes, especially in
adults [5, 6]. Reports on laparoscopic treatment
for mesenteric cysts in children are scarce. The
advent of digital surgery is bringing about
unprecedented changes to this centuries-old eld,
with robotic surgery experiencing rapid development. While its usage for pediatric cyst resection
is scarcely reported both domestically and overseas, this unique method is likely to see more
widespread application in the future. Therefore,
this chapter primarily discusses the use of the Da
Vinci robotic surgical system in the treatment of
mesenteric cysts in children.
15.2 Indications
andContraindications
• Indications
Mesenteric cysts that have either been
denitively diagnosed or highly suspected at a
small to medium size range, as well as giant
mesenteric cysts.
• Contraindications
The utilization of da Vinci robot-assisted
technology in the surgical treatment of mesenteric cysts has no absolute contraindications. However, there are several relative
contraindications that must be taken into consideration, including: (1) unstable vital signs
are unstable; (2) severe cardiopulmonary
insufciency and pneumoperitoneum intolerance; (3) urgent surgery required due to
abdominal distension complicated by strangulated intestinal obstruction; (4) past abdominal surgery with signicant adhesion in the
surgical area (5) secondary cyst infection
accompanied by peritonitis, where severe
intraperitoneal, and adhesions have occurred
from a ruptured cyst. In cases where a child
presents with the aforementioned conditions,
a thorough diagnosis and treatment plan must
be established, taking into account all relevant factors when considering whether Da
Vinci surgery is appropriate.
15.3 Preoperative Preparation
• Prior to surgery, it is essential to conduct an
individualized operation plan that includes
ultrasonic Doppler, CT, or MRI examinations
to better understand the relationship between
the size and location of the celiac cyst and the
surrounding tissue. This will help to ensure a
successful operation.
• In preparation for surgery, it is crucial to maintain stable internal conditions through preoperative rehydration correction. If intestinal
inammation is present, antibiotics should be
administered. Severe anemia patients may
require red blood cell corrective anemia suspension, while malnourished children may
require nutritional support to ensure optimal
conditions for surgery.
• In line with the ERAS concept, patients
should fast on semiuids for 6 hours and
abstain from water for 2 hours prior to surgery. Skin and blood should be prepared
accordingly. A glycerine enema must be
administered before surgery, and gastrointestinal decompression and catheterization
must be performed after anesthesia induction
to create additional abdominal operation
space.
• In the absence of overt abdominal infection,
second- or third -generation cephalosporins
can be used prophylactically for children.
These antibiotics should be administered
intravenously thirty minutes before surgery.
15.4 Position andDocking
• Position: conventional supine position
• Docking (adjusted according to the location
and size of the cyst)
To begin the surgery, an 8 mm median
umbilical incision into the abdomen was
made, and pneumoperitoneum was established. The Da Vinci trocar is inserted as the
primary mirror hole. The body surface projection of the mesenteric cyst and the umbilicus
Соседние файлы в папке @xirurgi_2025