Teaching and clinic application of trocar placement in the robotic hepatopancreaticobiliary surgery

Abstract

Objective Robotic surgery show enormous potential in Hepatopancreaticobiliary surgery during recent decades. However, the ports placements always be confused and related studies was deficiency. Therefore, our study aims to describe our experience with ports position in Robotic Hepato-Pancreato-Biliary Surgery (RHPBS) and to summarize the principle. Methods We retrospectively reviewed the medical records of 1 600 patients who underwent RHPBS by our surgery team between Nov. 2011 and Oct. 2017 at the PLA General Hospital in Beijing, China. It was included 1 048 cases of pancreatic surgery, 377 cases liver surgery, 118 cases biliary surgery and 57 cases other types of robotic surgery. In the early stage, we position the ports as traditional laparoscopy reference, then improve the ports position combine with intraoperative adjustment, thereby forming pattern of regular ports position for RHPBS. Results The four primary principles of RHPBS were concluded: Manipulation-oriented Peri-umbilicus Camera Port, Symmetry Operative-Arm Ports, Opposite Retractor-Arm Port, Eight centimeter Prots Rule, and the 3 patterns of perforation and 3 kinds of special perforation suitable for common and special hepatopancreaticobiliary surgery were formulated. Conclusions Ports position experience based on thousand cases was summarize and concluded and then it put forward follow the RHPBS ports position primary principle, that is easy to grasp the key points and facilitate the operation. Four primary principles of RHPBS well proven in safety, feasible and superiority. Standardization of regular robotic HPB surgery will improve the surgery accomplishment and patients′ prognosis. Key words: Robotic surgery; Minimally invasive surgery; Pancreas; Liver; Biliary tract; Teaching and training