Abstract
Background
The development of the Da Vinci robotic platform has drastically altered the paradigm of minimal invasive pancreatic surgery. However, the evidence of robotic total pancreatectomy (RTP) is still limited. Here we report an alternative approach of RTP, starting with pancreatoduodenectomy (the pancreatic head-first approach).
Methods
The patient was a 55-year-old female with a diagnosis of diffuse PNET in the head, body, and tail of the pancreas. The da Vinci Xi robotic system was used for RTP. Our technique of RTP consists of three steps: (1) pancreatoduodenectomy, (2) (en bloc) distal pancreatectomy, and (3) reconstructions.
Results
The operative time was 490 min with an estimated blood loss of 100 ml. The postoperative course was uneventful, and the patient was discharged on postoperative day 10.
Conclusions
RTP is a technically challenging procedure; however, the pancreatic head-first approach of RTP has several advantages.
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References
Strijker M, van Santvoort HC, Besselink MG, et al (2013) Robot-assisted pancreatic surgery: a systematic review of the literature. HPB (Oxford) 15:1-10
Konstantinidis IT, Jutric Z, Eng OS, et al (2018) Robotic total pancreatectomy with splenectomy: technique and outcomes. Surg Endosc 32:3691-3696
de Mesquita Neto JWB, Macedo FI, Liu Y, et al (2019) Fully robotic total pancreatectomy: technical aspects and outcomes. J Robot Surg 13:77-82
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Supplementary Information
Step 1 (pancreatoduodenectomy part). After Kocher’s maneuver including mobilization of the right colon and kocherization of the duodenum, the jejunum is pull into the right upper quadrant space and divided with a linear stapler. The stomach is also transected with a linear stapler. After ensuring complete identification of portal structures, the gastroduodenal artery and common bile duct are divided, followed with dissection of the infrapancreatic superior mesenteric vein (SMV). The pancreatic neck is not transected. Next, complete detachment of the unicinate process from the SMV and superior mesenteric artery is performed. Finally, the pancreatic head and duodenum are completely mobilized. (MP4 120,486 kb)
Step 2 (distal pancreatectomy part). The splenic artery and vein are identified and transected with a linear stapler. After dissection of the inferior border of the pancreas, the mobilization of pancreatic body is facilitated from medial towards the tail, followed with dissection around the spleen. Then specimen is retrieved through the Pfannenstiel incision. (MP4 74,400 kb)
Step 3 (reconstruction part). The interrupted hepaticojejunostomy and antecolic gastrojejunostomy. (MP4 85,038 kb)
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Takagi, K., Koerkamp, B.G. Robotic Total Pancreatectomy: A Novel Pancreatic Head-First Approach (with Video). J Gastrointest Surg 25, 1649–1650 (2021). https://doi.org/10.1007/s11605-021-04922-5
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DOI: https://doi.org/10.1007/s11605-021-04922-5