Robotic resection of the uncinate process of the pancreas

  • Marcel Autran C. MachadoEmail author
  • Rodrigo Surjan
  • Tiago Basseres
  • Fabio Makdissi
Case Report


Since the development of the robotic platform, the number of robotic-assisted surgeries has significantly increased. Robotic surgery has gained growing acceptance in recent years, expanding to pancreatic resection. Here, we report a total robotic resection of the uncinate process of the pancreas performed in a patient with a cystic neuroendocrine tumor. To our knowledge, this is the first report of a robotic resection of the uncinate process of the pancreas. A 46-year-old man with no specific medical history was diagnosed with a neuroendocrine tumor after undergoing routine imaging. Biopsy guided by echoendoscopy revealed a well-differentiated neuroendocrine tumor. We decided to perform a robotic resection of the uncinate process of the pancreas after obtaining informed consent for the procedure. According to preoperative echoendoscopy and magnetic resonance imaging, there was a safe margin between the neoplasm and the main pancreatic duct. The technique uses five ports. The duodenum is fully mobilized, and Kocher maneuver is carefully performed. The uncinate process of the pancreas is then identified. The resection of the uncinate process begins with the division of small arterial branches from the inferior pancreaticoduodenal artery in its inferior portion, followed by control of venous tributaries to the superior mesenteric vein. Intraoperative localization of the ampulla of Vater is performed using indocyanine green enhanced fluorescence, thus defining the superior margin of the uncinate process. The pancreatic division is made about 5 mm below its upper margin for safety. Surgical specimen is then retrieved through the umbilical port inside a plastic bag. The raw pancreatic area is covered with hemostatic tissue and drained. The total operation time was 215 min. The docking time was 8 min and console time was 180 min. Blood loss was minimum, estimated at less than 50 mL. The postoperative period was uneventful, except for hyperamylasemia in the drain fluid. The patient was discharged on the 3rd postoperative day. The final pathological report confirmed well-differentiated pancreatic neuroendocrine tumor. Robotic resection of the uncinate process of the pancreas is safe and feasible, providing parenchymal conservation in a minimally invasive setting. Robotic resection should be considered for patients suffering from low-grade pancreatic neoplasms located in this part of the pancreas.


Pancreas Uncinate process Robotic surgery Neuroendocrine tumor Parenchymal sparing 


Compliance with ethical standards

Conflict of interest

Marcel Autran Machado, Rodrigo Surjan, Tiago Basseres, and Fabio Makdissi declare that they have no conflict of interest.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975. Informed consent was obtained from the patient for being included in the study.

Consent section

Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


  1. 1.
    Nassour I, Choti MA, Porembka MR et al (2018) Robotic-assisted versus laparoscopic pancreaticoduodenectomy: oncological outcomes. Surg Endosc 32(6):2907–2913CrossRefGoogle Scholar
  2. 2.
    Machado MA, Makdissi FF, Surjan RC, Abdalla RZ (2009) Robotic resection of intraductal neoplasm of the pancreas. J Laparoendosc Adv Surg Tech A 19(6):771–775CrossRefGoogle Scholar
  3. 3.
    Rotellar F, Pardo F, Benito A et al (2011) Laparoscopic resection of the uncinate process of the pancreas: the inframesocolic approach and hanging maneuver of the mesenteric root. Surg Endosc 25(10):3426–3427CrossRefGoogle Scholar
  4. 4.
    Machado MA, Makdissi FF, Surjan RC, Machado MC (2009) Laparoscopic resection of the uncinate process of the pancreas. Surg Endosc 23(6):1391–1392CrossRefGoogle Scholar
  5. 5.
    Ichihara T, Shimada M, Horisawa M et al (1996) A case report: resection of the uncinate process of the pancreas for ultra-small pancreatic mucin-producing carcinoma of the branch type. Nihon Shokakibyo Gakkai Zasshi 93(6):445–450PubMedGoogle Scholar
  6. 6.
    Sharma MS, Brams DM, Birkett DH, Munson JL (2006) Uncinatectomy: a novel surgical option for the management of intraductal papillary mucinous tumors of the pancreas. Dig Surg 23(1–2):121–124CrossRefGoogle Scholar
  7. 7.
    Surjan RC, Basseres T, Makdissi FF et al (2017) Laparoscopic uncinatectomy: a more conservative approach to the uncinate process of the pancreas. Arq Bras Cir Dig 30(2):147–149CrossRefGoogle Scholar
  8. 8.
    NCCN. Neuroendocrine Tumors Guidelines (2018).

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Marcel Autran C. Machado
    • 1
    Email author
  • Rodrigo Surjan
    • 1
  • Tiago Basseres
    • 1
  • Fabio Makdissi
    • 1
  1. 1.Department of SurgeryUniversity of São Paulo, Hospital Nove de JulhoSão PauloBrazil

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