Robotic Pylorus-Preserving Pancreaticoduodenectomy

  • Sharona B. Ross
  • Darrell J. Downs
  • Iswanto Sucandy
  • Alexander S. Rosemurgy


The application and adoption of minimally invasive techniques in hepatopancreaticobiliary (HPB) surgery have been much slower when compared to other surgical disciplines such as urology, gynecology, colorectal, and bariatric surgery. Notably, HPB operations are uncommon, and they involve unusual complexity, with relatively high risk and “many moving parts.” The complexity of surgical steps undertaken during pancreaticoduodenectomy includes the precise dissection along major mesenteric vessels and reconstruction of biliary, pancreatic, and enteric anastomoses. There have been several variations of surgical techniques among centers that offer robotic pancreaticoduodenectomy. Our technique for pancreaticoduodenectomy is an outgrowth of our experience; herein, we describe our current technique for undertaking robotic pylorus-preserving pancreaticoduodenectomy.


Pancreaticoduodenectomy Pancreatic cancer Robotic surgery HPB surgery 


  1. 1.
    Fernandes E, Giulianotti PC. Robotic-assisted pancreatic surgery. J Hepatobiliary Pancreat Sci. 2013;20(6):583–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145(1):19–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim SC, Song KB, Jung YS, Kim YH, do Park H, Lee SS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc. 2013;27(1):95–103.CrossRefPubMedGoogle Scholar
  4. 4.
    Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepato-Biliary-Pancreat Surg. 2009;16(6):731–40.CrossRefGoogle Scholar
  5. 5.
    Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20(7):1045–50.CrossRefPubMedGoogle Scholar
  6. 6.
    Gumbs AA, Gayet B. The laparoscopic duodenopancreatectomy: the posterior approach. Surg Endosc. 2008;22(2):539–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, et al. Laparoscopic pancreaticoduodenectomy: a review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008;18(1):13–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Gagner M, Palermo M. Laparoscopic Whipple procedure: review of the literature. J Hepato-Biliary-Pancreat Surg. 2009;16(6):726–30.CrossRefGoogle Scholar
  9. 9.
    Ross SB, Downs D, Saeed SM, Dolce JK, Rosemurgy AS. Robotics in surgery: is a robot necessary? For what? Minerva Chir. 2017;72(1):61–70.PubMedGoogle Scholar
  10. 10.
    Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146(6):959–62.PubMedGoogle Scholar
  11. 11.
    Walsh RM, Chalikonda S. How I do it: hybrid laparoscopic and robotic pancreaticoduodenectomy. J Gastrointest Surg. 2016;20(9):1650–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd. 250 robotic pancreatic resections: safety and feasibility. Ann Surg. 2013;258(4):554–9. discussion 559–62PubMedPubMedCentralGoogle Scholar
  13. 13.
    Nguyen TK, Zenati MS, Boone BA, Steve J, Hogg ME, Bartlett DL, et al. Robotic pancreaticoduodenectomy in the presence of aberrant or anomalous hepatic arterial anatomy: safety and oncologic outcomes. HPB (Oxford). 2015;17(7):594–9.CrossRefGoogle Scholar
  14. 14.
    Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat. 2004;26(3):239–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Boone BA, Zenati M, Hogg ME, Steve J, Moser AJ, Bartlett DL, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg. 2015;150(5):416–22.CrossRefPubMedGoogle Scholar
  16. 16.
    Fisher WE, Hodges SE, Wu MF, Hilsenbeck SG, Brunicardi FC. Assessment of the learning curve for pancreaticoduodenectomy. Am J Surg. 2012;203(6):684–90.CrossRefPubMedGoogle Scholar
  17. 17.
    Rosemurgy AS, Downs D, Swaid F, Ross SB. Laparoendoscopic Single-Site (LESS) Nissen fundoplication: how we do it. J Gastrointest Surg. 2016;20(12):2093–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Sukharamwala P, Teta A, Ross S, Co F, Alvarez-Calderon G, Luberice K, et al. Over 250 Laparoendoscopic Single Site (LESS) Fundoplications: lessons learned. Am Surg. 2015;81(9):870–5.PubMedGoogle Scholar
  19. 19.
    Mathur A, Luberice K, Ross S, Choung E, Rosemurgy A. Pancreaticoduodenectomy at high-volume centers: surgeon volume goes beyond the leapfrog criteria. Ann Surg. 2015;262(2):e37–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Ryan CE, Ross SB, Sukharamwala PB, Sadowitz BD, Wood TW, Rosemurgy AS. Distal pancreatectomy and splenectomy: a robotic or LESS approach. JSLS. 2015;19(1):e2014.00246.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ryan CE, Wood TW, Ross SB, Smart AE, Sukharamwala PB, Rosemurgy AS. Pancreaticoduodenectomy in Florida: do 20-year trends document the salutary benefits of centralization of care? HPB (Oxford). 2015;17(9):832–8.CrossRefGoogle Scholar
  22. 22.
    Rosemurgy A, Cowgill S, Coe B, Thomas A, Al-Saadi S, Goldin S, Zervos E. Frequency with which surgeons undertake pancreaticoduodenectomy continues to determine length of stay, hospital charges, and in-hospital mortality. J Gastrointest Surg. 2008;12:442–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, et al. Robotic distal pancreatectomy: cost effective? Surgery. 2010;148(4):814–23.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sharona B. Ross
    • 1
  • Darrell J. Downs
    • 1
  • Iswanto Sucandy
    • 1
  • Alexander S. Rosemurgy
    • 1
  1. 1.Department of SurgeryFlorida Hospital TampaTampaUSA

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