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Surgical Endoscopy

, Volume 32, Issue 8, pp 3691–3696 | Cite as

Robotic total pancreatectomy with splenectomy: technique and outcomes

  • Ioannis T. Konstantinidis
  • Zeljka Jutric
  • Oliver S. Eng
  • Susanne G. Warner
  • Laleh G. Melstrom
  • Yuman Fong
  • Byrne Lee
  • Gagandeep SinghEmail author
Video

Abstract

Background

Robotic total pancreatectomy (TP) represents a minimally invasive approach to a major intra-abdominal operation. Its utility, technique, and outcomes are evolving.

Methods

In this video, we describe a systematic approach to a robotic total pancreatectomy performed for multifocal intraductal papillary mucinous neoplasm (IPMN). Additionally, we reviewed the National Cancer Database (NCDB) to examine the outcomes of robotic TP compared to laparoscopic and open TP between 2010 and 2014.

Results

The patient is a 61-year-old female who was diagnosed with multifocal IPMN. A total of 6 robotic ports were placed and the da Vinci Xi robotic system was used with the patient supine. The approach entailed as follows: (1) Diagnostic laparoscopy; (2) Entry into the lesser sac; (3) Division of the short gastric vessels; (4) Exposure and dissection of the inferior pancreas border; (5) Dissection and transection of the splenic artery; (6) Mobilization of the pancreas tail/spleen; (7) Exposure of the splenic vein-superior mesenteric vein confluence; (8) Kocher maneuver; (9) Release of the ligament of Treitz and transection of the proximal jejunum; (10) Transection of the distal stomach; (11) Portal lymphadenectomy; (12) Dissection and transection of the gastroduodenal artery; (13) Superior mesenteric vein exposure/dissection of the uncinate process; (14) Hepaticojejunostomy; (15) Cholecystectomy; and (16) Gastrojejunostomy. NCDB database review of 73 patients who underwent robotic TP revealed similar rates of margin negative resections and retrieved lymph nodes between robotic, laparoscopic, and open TP, whereas robotic and laparoscopic TP were associated with shorter in-hospital stay and reduced mortality at 30 and 90 days compared to open TP. Overall median survival of pancreatic adenocarcinoma patients who underwent TP was similar between robotic, laparoscopic, and open approaches.

Conclusion

Robotic total pancreatectomy with splenectomy offers a minimally invasive approach to a major abdominal operation and is feasible in a stepwise, reproducible technique. It is associated with improved postoperative outcomes and equivalent oncologic outcomes compared to open TP.

Keywords

Robotic total pancreatectomy National cancer database Postoperative outcomes 

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Notes

Compliance with ethical standards

Disclosures

Ioannis T. Konstantinidis, Zeljka Jutric, Oliver S. Eng, Susanne G. Warner, Laleh G. Melstrom, Yuman Fong, Byrne Lee, Gagandeep Singh have no conflicts of interest. Additionally, the authors do not have any conflict of interest with Intuitive Surgical.

Supplementary material

Supplementary material 1 (M4V 241834 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Ioannis T. Konstantinidis
    • 1
  • Zeljka Jutric
    • 1
  • Oliver S. Eng
    • 1
  • Susanne G. Warner
    • 1
  • Laleh G. Melstrom
    • 1
  • Yuman Fong
    • 1
  • Byrne Lee
    • 1
  • Gagandeep Singh
    • 1
    Email author
  1. 1.Department of SurgeryCity of Hope National Medical CenterDuarteUSA

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