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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_541_Библиотеки_им_академика_М_И_Перельмана.pdf
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Fig. 12.2 Preoperative CT (coronary image) demonstrates the location
of the GIST within the descending part of the duodenum
T. Glatz and D. Bausch
Duodenum
Colon
Fig. 12.4 Mobilization of the hepatic exure and exposure of the duodenum with the monopolar hook
Fig. 12.3 Trocar positioning: right-sided supraumbilical position of
the robotic trocars with angulated 12mm assistant trocar between arms
3 and 4
Duodenum
Fig. 12.5 Kocher maneuver: the duodenum is retracted upward with
the third arm to create maximum tension
12 Robotic Duodenectomy
115
Duodenum
V. cava
Duodenum
Fig. 12.6 Kocher maneuver: incision of the dorsal attachments
Duodenum
Pancreatic
head
vessels
Right colic
Fig. 12.7 Kocher maneuver: visualization of the pancreatic head and
the right colonic vessels
Fig. 12.8 Kocher maneuver: dissection of the duodenum from the
vena cava
Duodenum
1st jejunal
loop
Right colic
vessels
Fig. 12.9 Kocher maneuver: completion by incision of the ligament of
Treitz and visualization of the rst jejunal loop
116
Duodenum
GIST
T. Glatz and D. Bausch
Pancreatic
head
GIST
Pancreatic
head
Duodenum
Fig. 12.10 Exposure of the GIST within the descending part of the
duodenum
Duodenum
Pancreatic
head
Fig. 12.11 Dissection of the duodenum from the pancreatic head
Fig. 12.12 Dissection of the tumor from the pancreatic head
Pancreatic
head
GIST
Duodenum
Fig. 12.13 Exposure of the proximal duodenum
12 Robotic Duodenectomy
117
Gallbladder
Duodenum
Colon
Fig. 12.14 Dorsal completion of the duodenal mobilization
Gallbladder
Duodenum
Duodenum
Pancreas
Fig. 12.16 Completion of the duodenal dissection from the pancreatic
head
GIST
Duodenum
Fig. 12.15 Transection of the proximal duodenum the robotic stapler
GIST
Fig. 12.17 Resected tumor with distal duodenum
118
1st jejunal loop
T. Glatz and D. Bausch
1st jejunal loop
Fig. 12.18 Dissection of the jejunal mesentery with a bipolar sealing
device
1st jejunal loop
Fig. 12.19 Transection of the jejunum with the robotic stapler
Fig. 12.20 Completion of the mobilization of the rst jejunal loop
1st jejunal loop
Pancreas
Fig. 12.21 Pull-through of the rst jejunal loop under the mesenteric
root
12 Robotic Duodenectomy
119
Gallbladder
Common bile duct
Cystic duct
Fig. 12.22 Cholecystectomy: mobilization of the gallbladder
Gallbladder
Gallbladder
Cystic artery
Fig. 12.24 Cholecystectomy: identication of the cystic artery and
duct
Cystic artery
Fig. 12.23 Cholecystectomy: dissection of the gallbladder from the
liver
Fig. 12.25 Cholecystectomy: ligation of the cystic artery by clipping
120
T. Glatz and D. Bausch
Fogarty catheter
Cystic duct
Duodenum
Fig. 12.26 Incision of the cystic duct
Fogarty catheter
Cystic duct
Fig. 12.27 Insertion of a Fogarty catheter into the cystic duct
Fig. 12.29 Guaranteeing the preservation of the major duodenal
papilla by visualizing the Fogarty catheter within the duodenum
Cystic duct
Fig. 12.30 Ligation of the cystic duct after removal of the catheter by
double clipping
Duodenum
Fig. 12.28 Incision of the duodenum
Stomach
12 Robotic Duodenectomy
121
1st jejunal loop
Fig. 12.31 Positioning of the jejunum for double-layered side-to-side
anastomosis
1st jejunal loop
duodenum
1st jejunal loop
duodenum
Fig. 12.33 Anastomotic technique: incision of the jejunum and
enlargement of the duodenal incision
duodenum
1st jejunal loop
Fig. 12.32 Anastomotic technique: side-to-side alignment of the duodenum and jejunum by a running 4-0 barbed suture (PDS)
Fig. 12.34 Anastomotic technique: fashioning of the second dorsal
layer by running 4-0 barbed suture (PDS)
122
T. Glatz and D. Bausch
duodenum
1st jejunal loop
Fig. 12.35 Anastomotic technique: completion of the dorsal layers
duodenum
duodenum
1st jejunal loop
Fig. 12.37 Anastomotic technique: completion of the inner front layer
and securing of the inner layer by knotting of the two sutures
duodenum
1st jejunal loop
Fig. 12.36 Anastomotic technique: fashioning of the inner front layer
by a separate running 4-0 barbed suture (PDS)
1st jejunal loop
Fig. 12.38 Anastomotic technique: fashioning of the second front
layer
12 Robotic Duodenectomy
123
duodenum
1st jejunal loop
Fig. 12.39 Double layered side-to-side duodenojejunostomy after
completion
specimen
drain
Fig. 12.41 Drain placement at the anastomosis
References
1. Chung RS, Church JM, van Stolk R. Pancreas-sparing
duodenectomy:indications, surgical technique, and results. Surgery.
1995;117(3):254–9.
2. Kokosis G, Ceppa EP, Tyler DS, Pappas TN, Perez A.Laparoscopic
duodenectomy for benign nonampullary duodenal neoplasms. Surg
Laparosc Endosc Percutan Tech. 2015;25(2):158–62.
3. Ojima T, Nakamura M, Hayata K, Kitadani J, Katsuda M, Takeuchi
A, Tominaga S, Yamaue H. J laparoscopic limited resection for
duodenal gastrointestinal stromal tumors. Gastrointest Surg.
2020;24(10):2404–8.
Fig. 12.40 Extraction of the specimen via assistant port