Management of Intra-Operative Hemorrhage and Safe Venous Resection in Robotic-Assisted Pancreaticoduodenectomy: Techniques to Avoid Open Conversion

Abstract

Robotic-assisted pancreaticoduodenectomy (RPD) is increasingly utilized for operable periampullary malignancies with oncologic outcomes compared to the open approach. Indications can be carefully expanded to select borderline resectable tumors, but bleeding remains a significant threat. Moreover, the need for venous resection and reconstructions increases as more complex cases are selected to undergo RPD. Herein, we present a video compilation of our approach to safe venous resections during RPD, followed by several video examples of intraoperative hemorrhage highlighting various techniques and tips that the console and bedside surgeon can utilize to control bleeding. Conversion to an open procedure should not be seen as a failure but rather as a safe and sound intraoperative decision made in the patient’s best interest. Nonetheless, with experience and proper technique, many intraoperative hemorrhages and venous resections can be managed in a minimally invasive fashion.