Side-to-side lateral pancreaticojejunostomy is commonly used to treat chronic pancreatitis. It is usually performed via a laparotomy due to the technical challenges of constructing a pancreatico-enteric anastomosis laparoscopically. The robotic system offers improved visualization and dexterity in fashioning such a complex anastomosis.
A 58-year-old veteran was diagnosed with a gallstone-induced chronic pancreatitis and malnutrition due to intractable abdominal pain. The patient had previously undergone laparoscopic cholecystectomy. Preoperative ERCP revealed an obstructing pancreatic duct stone in the head of the pancreas with associated upstream duct dilatation. The patient had failed multiple attempts to access and stent the pancreatic duct, including unsuccessful cannulation of the minor papilla. Pancreatic protocol CT scan demonstrated a well-developed pseudocyst in communication with the dilated pancreatic duct. The video explains in details the operative steps. He was discharged home on POD #4. There were no complications during his hospitalization and at 6 months follow-up.
Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy is feasible and safe. The robot system offers the advantage of a true three-dimensional view based on a double optical system, in addition to a wide range of freedom of motion, which contributes to the feasibility of this advanced laparoscopic suturing.
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Eid, G.M., Entabi, F., Watson, A.R. et al. Robotic-Assisted Laparoscopic Side-to-Side Lateral Pancreaticojejunostomy. J Gastrointest Surg 15, 1243 (2011) doi:10.1007/s11605-011-1495-9