اوﻟﯿﻦ ﮔﺰارش از ﺟﺮاﺣﯽ وﯾﭙﻞ ﻻﭘﺎروﺳﮑﻮﭘﯿﮏ در اﯾﺮان

The First Report of Totally Laparoscopic Pancreaticoduodenectomy in Iran

ﺟﺮاﺣﯽﻫﺎي ﻻﭘﺎروﺳﮑﻮﭘﯿﮏ ﺑﻪ ﻃﻮر ﮔﺴﺘﺮدهاي در ﺟﻬﺎن ﭘﺬﯾﺮﻓﺘﻪ ﺷﺪهاﻧﺪ. در ﺳﺎلﻫﺎي اﺧﯿﺮ اﻧﺠﺎم ﺧﯿﻠﯽ از ﺟﺮاﺣﯽﻫﺎ ﺑﺎ ﻻﭘﺎروﺳﮑﻮﭘﯽ ﻣﻌﺮﻓﯽ ﺷﺪه اﺳﺖ. ﭘﺎﻧﮑﺮاﺗﯿﮑﻮدﺋﻮدﻧﮑﺘﻮﻣﯽ ﯾﮑﯽ از ﺟﺮاﺣﯽﻫﺎي ﭘﯿﭽﯿﺪه ﺷﮑﻤﯽ اﺳﺖ. ﺑﺪﻟﯿﻞ ﻣﺸﮑﻞ ﺑﻮدن اﯾﻦ ﺟﺮاﺣﯽ ﺑﻪ روش ﻻﭘﺎروﺳﮑﻮﭘﯿﮏ زﯾﺎد اﻧﺠﺎم ﻧﻤﯽﮔﺮدد و ﺑﻪ ﻧﻈﺮ ﺗﺎ ﺣﺎﻻ در اﯾﺮان اﯾﻦ ﺷﯿﻮه ﺟﺮاﺣﯽ ﮔﺰارش ﻧﺸﺪه اﺳﺖ. ﮔﺰارش ﻣﻮﺟﻮد اوﻟﯿﻦ ﺟﺮاﺣﯽ ﺗﻤﺎﻣﺎً ﻻﭘﺎروﺳﮑـﻮﭘﯿﮏ ﭘﺎﻧﮑﺮاﺗﯿﮑﻮدﺋﻮدﻧﮑﺘﻮﻣﯽ را در اﯾﺮان اﻋﻼم ﻣﯽدارد. ﺑﯿﻤﺎر ﺧﺎﻧﻢ 57 ﺳﺎﻟﻪاي ﻫﺴﺘﻨﺪ ﮐﻪ ﺑﺎ زردي و درد ﺷﮑﻢ در ﺑﯿﻤﺎرﺳﺘﺎن ﻣﺪرس ﺗﻬـﺮان ﺑﺴﺘﺮي ﺷﺪﻧﺪ. ﺑﺮرﺳﯽﻫﺎي ﺗﺸﺨﯿﺼﯽ آدﻧﻮﮐﺎرﺳﯿﻨﻮﻣﺎي آﻣﭙﻮل واﺗﺮ را ﻧﺸﺎن داد. ﺑﻌﺪ از اﻗﺪاﻣﺎت اوﻟﯿﻪ، ﺑﯿﻤﺎر ﺗﺤﺖ ﭘﺎﻧﮑﺮاﺗﯿﮑـﻮدﺋﻮدﻧﮑﺘﻮﻣﯽ )وﯾﭙﻞ( واﻗﻊ ﺷﺪ. دوره ﻧﻘﺎﻫﺖ ﺑﯿﻤﺎر ﺑﺪون ﻣﺸﮑﻞ ﺧﺎﺻﯽ ﻃﯽ ﮔـﺮدﯾﺪ و روز ﻫﺸﺘﻢ ﺑﻌﺪ از ﺟﺮاﺣﯽ ﻣﺮﺧﺺ ﮔﺮدﯾﺪ. وﯾﭙﻞ ﻻﭘﺎروﺳﮑﻮﭘﯿﮏ ﺑﻪ دﻟﯿﻞ ﺗﻬﺎﺟﻢ ﮐﻤﺘﺮ، درد و اﻗﺎﻣﺖ ﺑﻌﺪ از ﺟﺮاﺣﯽ ﮐﻤﺘﺮ ﺣﺎﺋﺰ اﻫﻤﯿﺖ ﺑﻮده در ﻣﻮارد ﻣﻨﺎﺳﺐ ﺗﻮﺻﯿﻪ ﻣﯽﺷﻮد.

Laparoscopic procedures have been widely accepted worldwide. During recent years, many procedures have been introduced laparoscopically. Pancreaticoduodenectomy is one of the complex procedures in abdominal surgery. Because of complexity of this procedure, its laparoscopic form has not been performed frequently. To our knowledge, totally laparoscopic Pancreaticoduodenectomy has not been reported in Iran. The following case demonstrates first totally laparoscopic Pancreaticoduodenectomy in Iran. A 57 year-old woman was admitted in surgical ward of Shahid Modarres hospital, Tehran, Iran, with icterus and abdominal pain. Diagnostic evaluations revealed Periampullary adenocarcinoma. After appropriate preoperative measures, she underwent totally laparoscopic Pancreaticoduodenectomy. The postoperative period was uneventful and patient discharged on the 8th postoperative day. Histopathological evaluation confirmed the diagnosis of Periampullary adenocarcinoma. Totally laparoscopic Pancreaticoduodenectomy is one of the complex laparoscopic abdominal procedures, which had not already been performed in Iran. Because of advantages of minimally invasiveness and lesser postoperative pain and shorter hospital stay, it can be recommended in selected cases.