It was performed a retrospective analysis of the results of distal pancreatic resections (DPR) in 89 patients with different tumors. Conventional open operations were performed in 60 patients, robot-assisted - in 19 patients, laparoscopic - in 10 cases. Absolute indication for open surgery was pancreatic cancer T3-4 stages. Mini-invasive distal resections (robot-assisted and laparoscopic) were performed in cases of pancreatic cancer T1-2 stages, benign tumors and tumors with low potential of malignancy and diameter up to 4-5 cm. Results of robot-assisted and laparoscopic interventions are similar but robot-assisted technique provides more precise surgery. It improves quality of lymphadenectomy, decreases probability of intraoperative bleeding. Duration of robot-assisted and open operation did not differ significantly. Blood loss was significantly lower in group of robot-assisted method (mean 470 ml) while in cases of open and laparoscopic techniques this parameter was 1013.8 and 833.3 ml respectively. Postoperative complications in open, laparoscopic and robot-assisted groups developed in 45.1, 52.6 and 50% of observations respectively. Pancreatic fistulas were revealed in 58.8, 80 and 58.3% of cases respectively. There were not deaths after laparoscopic and robot-assisted pancreatic resections. 2 patients died after open surgery.
Хирургия поджелудочной железы весьма специфична. Бóльшая часть операций на этом органе требует специальных мануальных навыков, знания возможных вариантов сосудистой архитектоники и специфики патофизиологических реакций поджелудочной железы как на болезнь, поразившую орган, так и на операционную травму. Существует не много хирургических клиник, в которых радикально и успешно выполняют операции по поводу опухолей поджелудочной железы и хронического панкреатита. Институт хирургии им. А.В. Вишневского стоял у истоков отечественной хирургической панкреатологии. Благодаря инициативе руководителей института-академиков А.В. Вишневского, М.И. Кузина и
<b><i>Background:</i></b> Proinsulinoma is a neuroendocrine tumor (NET) of the pancreas that produces prohormone proinsulin. These tumors are very rare. In the literature, they are most often presented in the form of case reports. <b><i>Materials and Methods:</i></b> We studied 177 patients with NET of the pancreas who underwent surgical treatment in the A.V. Vishnevsky National Medical Research Centre of Surgery from January 2007 to December 2018. <b><i>Results:</i></b> Of 81 patients with organic hyperinsulinism caused by functioning NETs of the pancreas during the study period, 3 (3.7%) had a proinsulinoma; 2 were female; and 1 was male. None of them admitted to weight gain during this period, and their BMI was normal. All patients presented with Whipple’s triad during the 72-h fast. Tumor-enucleating surgery was performed: one robot assisted, two laparotomies. A normal glucose level after treatment was achieved in all cases. <b><i>Conclusion:</i></b> In cases where clinical hypoglycemia is present, but the serum insulin level is within the normal range or even decreased, proinsulinoma should be suspected. For now, surgical resection remains the only effective method of treatment. Further investigation of proinsulinomas is needed.
Vascular leiomyosarcoma is a rare tumor originating from the vascular smooth muscle cells. Leiomyosarcomas of the external iliac vein are extremely rare. Only single observations of this tumor are reported. We describe a 48-year-old woman who underwent a two-step combined treatment: robot-assisted removal of the extraperitoneal tumor and removal of the lower part of the tumor from the open femoral approach. There have been no signs of tumor recurrence during the 34-month follow-up period.
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