The most common indication for pancreaticoduodenectomy (PD) is the presence of malignant or premalignant neoplasm in the head of the pancreas or peripancreatic structures such as the bile duct, ampulla, or duodenum. In this chapter, a reproducible step-by-step technique for robotic PD that follows the natural flow of open PD is described. After discussion of the indications and preoperative workup that is mostly the same as open PD, a description of patient positioning and port placement follows. The operation starts with a brief laparoscopic exploration, and if the tumor is deemed resectable, mobilization of the proximal jejunum to the stomach follows as early setup for later reconstruction. Subsequently, the robotic system is docked. Detailed description of the resection phase, followed by the reconstruction phase, is accompanied by images. To conclude, postoperative care is explained and a brief literature review about the outcomes of robotic PD is presented.
KeywordsRobotic pancreaticoduodenectomy Robotic Whipple Robotic pancreatic surgery Minimally invasive pancreaticoduodenectomy
In this video of 6′:40″, we present the basic steps of the robotic pancreaticoduodenectomy. The video starts with positioning and suturing the jejunal limb to the stomach to assist with the future creation of the gastrojejunostomy (start to 0:30″). Subsequently, the early division of the stomach is depicted (0:51″–1:10″), followed by securing the gallbladder to the wall (1:12″–1:23″) and the dissection of the superior pancreatic node (1:12″–1:57″). The creation of the tunnel behind the neck of the pancreas (1:59″–2:20″) is followed by the division of the pancreas parenchyma (2:23″–2:36″). In our technique, a wide Kocher maneuver, with mobilization and division of the proximal small bowel, is performed next (2:38″–3:20″). The video finishes with the creation of the pancreaticojejunostomy (3:55″–5:37″), the hepaticojejunostomy (5:39″–6:18″), and, finally, the gastrojejunostomy (6:19″–6:20″) (MP4 1043594 kb)
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