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Robotic Pancreatoduodenectomy in Portal Annular Pancreas Using a Hanging Maneuver with Indocyanine Green Fluorescence Imaging

  • Pancreatic Tumors
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Abstract

Background

Sufficient knowledge and surgical management of portal annular pancreas (PAP) are essential for pancreatic surgery. As PAP is a relatively rare pancreatic anomaly, few studies have described surgical techniques for patients with PAP undergoing robotic pancreatoduodenectomy (RPD).

Patients and Methods

An 82-year-old female patient who underwent RPD presented with distal cholangiocarcinoma and type III PAP (the fusion of the uncinate process with the anteportal main pancreatic duct). After the Kocher maneuver and stomach transection, the pancreas was transected into the neck of the anteportal portion. The retroportal portion was dissected, encircled with hanging tape, and compressed. Blood supply from the mesenteric vessels was confirmed using indocyanine green (ICG) fluorescence imaging. Subsequently, the retroportal portion was stapled.

Conclusions

This study demonstrates a unique surgical technique for type III PAP using the hanging maneuver with ICG fluorescence imaging. Surgeons should decide on the surgical strategy on the basis of the fusion and ductal anatomy of the pancreas.

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Acknowledgment

Financial support was provided by the Japan Society for the Promotion of Science (Grant No. 21K16447).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan

    Kosei Takagi MD, PhD, Tomokazu Fuji MD, PhD, Motohiko Yamada MD, Jiro Kimura MD, Kazuya Yasui MD, Yuzo Umeda MD, PhD & Toshiyoshi Fujiwara MD, PhD

Authors
  1. Kosei Takagi MD, PhD
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  2. Tomokazu Fuji MD, PhD
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  3. Motohiko Yamada MD
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  4. Jiro Kimura MD
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  5. Kazuya Yasui MD
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  6. Yuzo Umeda MD, PhD
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  7. Toshiyoshi Fujiwara MD, PhD
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Corresponding author

Correspondence to Kosei Takagi MD, PhD.

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The authors declare that they have no conflict of interest.

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Ethical approval was not required because this was a single report and not a trial or observational study. Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.

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Video 1. Robotic pancreatoduodenectomy in type III portal annular pancreas using a hanging maneuver with indocyanine green fluorescence imaging (MP4 239882 kb)

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Takagi, K., Fuji, T., Yamada, M. et al. Robotic Pancreatoduodenectomy in Portal Annular Pancreas Using a Hanging Maneuver with Indocyanine Green Fluorescence Imaging. Ann Surg Oncol 31, 1933–1936 (2024). https://doi.org/10.1245/s10434-023-14685-9

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  • DOI: https://doi.org/10.1245/s10434-023-14685-9

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