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The standardized technique in robotic radical antegrade modular pancreatosplenectomy using the flip-up approach

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Abstract

Purpose

Radical antegrade modular pancreatosplenectomy (RAMPS) was first introduced in 2003. It has been accepted as an alternative technique for pancreatic cancer of the body and tail. However, robotic RAMPS is not yet popular because of its technical difficulty and lack of standardized technique. This study describes in detail the standard steps of robotic RAMPS using the flip-up approach with the benefit of a robotic view when treating pancreatic cancer of the body and tail.

Method

We took advantage of our single-center experience to provide a step-by-step technique of robotic RAMPS procedure using the da Vinci Si system.

Results

We divided the procedure into 11 key steps. The surgical steps are optimized to achieve margin-negative curative resection and sufficient regional lymphadenectomy. The artery-first approach is usually used to determine tumor resectability early before performing an irreversible operative step. We also determine the borders of surgical resection and divide the splenic artery after dividing the pancreatic neck and the splenic vein, which facilitates a complete lymphadenectomy around the celiac axis with a bottom-up view.

Conclusion

Robotic RAMPS using the flip-up approach is safe and feasible in performing curative resection for well-selected pancreatic cancer of the body and tail. A randomized controlled trial comparing open and robotic RAMPS is needed in the future.

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Author information

Author notes

  1. Qu Liu and Guodong Zhao contributed equally to this work.

Authors and Affiliations

  1. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Qu Liu, Guodong Zhao, Zhiming Zhao, Xiuping Zhang, Yuanxing Gao, Xianglong Tan & Rong Liu

Authors
  1. Qu Liu
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  2. Guodong Zhao
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  3. Zhiming Zhao
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  4. Xiuping Zhang
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  5. Yuanxing Gao
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  6. Xianglong Tan
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  7. Rong Liu
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Contributions

Study concept and design: QL, GZ, ZZ, and RL. Performance of operation: ZZ, GZ, and RL. Acquisition of data: XZ, YG, and XT. Analysis and interpretation of data: QL, GZ, and XZ. Drafting of the manuscript: QL and GZ. Critical revision of the manuscript for important intellectual content: QL, GZ, and RL.

Corresponding author

Correspondence to Rong Liu.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the Declaration of Helsinki.

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Written informed consent was obtained from patient for publication of this report and any associated images.

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The authors declare no conflict of interest.

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Liu, Q., Zhao, G., Zhao, Z. et al. The standardized technique in robotic radical antegrade modular pancreatosplenectomy using the flip-up approach. Langenbecks Arch Surg 406, 1697–1703 (2021). https://doi.org/10.1007/s00423-021-02113-z

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  • DOI: https://doi.org/10.1007/s00423-021-02113-z

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