Skip to main content

Advertisement

SpringerLink
Log in

Robotic pancreatoduodenectomy with vascular resection

  • REVIEW ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV).

Methods

Our experience on RPD, including RPD-SMV/PV, is presented along with a description of the surgical technique and a systematic review of the literature on RPD-SMV/PV.

Results

We have performed 116 RPD and 14 RPD-SMV/PV. Seven additional cases of RPD-SMV/PV were identified in the literature. In our experience, RPD and RPD-SMV/PV were similar in all baseline variables, but lower mean body mass and higher prevalence of pancreatic cancer in RPD-SMV/PV. Regarding the type of vein resection, there were one type 2 (7.1 %), five type 3 (35.7 %) and eight type 4 (57.2 %) resections. As compared to RPD, RPD-SMV/PV required longer operative time, had higher median estimated blood loss, and blood transfusions were required more frequently. Incidence and severity of post-operative complications were not increased in RPD-SMV/PV, but post-pancreatectomy hemorrhage occurred more frequently after this procedure. In pancreatic cancer, RPD-SMV/PV was associated with a higher mean number of examined lymph nodes (60.0 ± 13.9 vs 44.6 ± 11.0; p = 0.02) and with the same rate of microscopic margin positivity (25.0 % vs 26.1 %). Mean length or resected vein was 23.1 ± 8.08 mm. Actual tumour infiltration was discovered in ten patients (71.4 %), reaching the adventitia in four patients (40.0 %), the media in two patients (20.0 %), and the intima in four patients (40.0 %). Literature review identified seven additional cases, all reported to have successful outcome.

Conclusions

RPD-SMV/PV is feasible in carefully selected patients. The generalization of these results remains to be demonstrated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Crile G Jr (1970) The advantages of bypass operations over radical pancreatoduodenectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet 130:1049–1053

    PubMed  Google Scholar 

  2. Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M, Ogata Y, Hishinuma S, Asano T, Aikou T, Hosotani R, Maetani S (2004) A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery 136:1003–1011

    Article  PubMed  Google Scholar 

  3. Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, Büchler MW, Werner J (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254:311–319. doi:10.1097/SLA.0b013e31821fd334

    Article  PubMed  Google Scholar 

  4. Nordby T, Ikdahl T, Bowitz Lothe IM, Fagerland MW, Heiberg T, Hauge T, Labori KJ, Buanes T (2013) Improved survival and quality of life in patients undergoing R1 pancreatic resection compared to patients with locally advanced unresectable pancreatic adenocarcinoma. Pancreatology 13:180–185. doi:10.1016/j.pan.2013.01.003

    Article  PubMed  Google Scholar 

  5. Gooiker GA, van Gijn W, Wouters MW, Post PN, van de Velde CJ, Tollenaar RA (2011) Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg 98:485–494

    Article  CAS  PubMed  Google Scholar 

  6. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825

    Article  CAS  PubMed  Google Scholar 

  7. Buanes TA (2014) Pancreatic cancer-improved care achievable. World J Gastroenterol 20:10405–10418. doi:10.3748/wjg.v20.i30.10405

    Article  PubMed  PubMed Central  Google Scholar 

  8. Simianu VV, Zyromski NJ, Nakeeb A, Lillemoe KD (2010) Pancreatic cancer: progress made. Acta Oncol 49:407–417. doi:10.3109/02841860903447051

    Article  PubMed  Google Scholar 

  9. Hidalgo M (2010) Pancreatic cancer. New Engl J Med 362:1605–1617. doi:10.1056/NEJMra0901557

    Article  CAS  PubMed  Google Scholar 

  10. Tempero MA, Malafa MP, Behrman SW, Benson AB 3rd, Casper ES, Chiorean EG, Chung V, Cohen SJ, Czito B, Engebretson A, Feng M, Hawkins WG, Herman J, Hoffman JP, Ko A, Komanduri S, Koong A, Lowy AM, Ma WW, Merchant NB, Mulvihill SJ, Muscarella P 2nd, Nakakura EK, Obando J, Pitman MB, Reddy S, Sasson AR, Thayer SP, Weekes CD, Wolff RA, Wolpin BM, Burns JL, Freedman-Cass DA (2014) Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 12:1083–1093

    CAS  Google Scholar 

  11. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155:977–988. doi:10.1016/j.surg.2014.02.001

    Article  PubMed  Google Scholar 

  12. Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I (2016) Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg 103:179–191. doi:10.1002/bjs.9969

    Article  CAS  PubMed  Google Scholar 

  13. Boggi U, Napoli N, Costa F, Kauffmann EF, Menonna F, Iacopi S, Vistoli F, Amorese G (2016) Robotic-assisted pancreatic resections. World J Surg. doi:10.1007/s00268-016-3565-3

    PubMed  Google Scholar 

  14. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–638 . doi:10.1097/SLA.0000000000000937discussion 638-640

    Article  PubMed  Google Scholar 

  15. Zeh HJ, Zureikat AH, Secrest A, Dauoudi M, Bartlett D, Moser AJ (2012) Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol 19:864–870. doi:10.1245/s10434-011-2045-0

    Article  PubMed  Google Scholar 

  16. Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F (2013) Feasibility of robotic pancreaticoduodenectomy. Br J Surg 100:917–925. doi:10.1002/bjs.9135

    Article  CAS  PubMed  Google Scholar 

  17. Boggi U, Vistoli F, Signori S, D'Imporzano S, Amorese G, Consani G, Guarracino F, Melfi F, Mussi A, Mosca F (2011) Robotic renal transplantation: first European case. Transpl Int 24:213–218. doi:10.1111/j.1432-2277.2010.01191.x

    Article  PubMed  Google Scholar 

  18. Boggi U, Belluomini MA, Barbarello L, Caniglia F, Brunetto M, Amorese G (2015) Laparoscopic robot-assisted distal splenorenal shunt. Surgery 157:405. doi:10.1016/j.surg.2014.07.012

    Article  PubMed  Google Scholar 

  19. Boggi U, Signori S, Vistoli F, D'Imporzano S, Amorese G, Consani G, Guarracino F, Marchetti P, Focosi D, Mosca F (2012) Laparoscopic robot-assisted pancreas transplantation: first world experience. Transplantation 93:201–206. doi:10.1097/TP.0b013e318238daec

    Article  PubMed  Google Scholar 

  20. Boggi U, Moretto C, Vistoli F, D'Imporzano S, Mosca F (2009) Robotic suture of a large caval injury caused by endo-GIA stapler malfunction during laparoscopic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein. Minim Invasive Ther Allied Technol 18:306–310. doi:10.1080/13645700903201001

    Article  PubMed  Google Scholar 

  21. Pietrabissa A, Boggi U, Vistoli F, Moretto C, Ghilli M, Mosca F (2004) Laparoscopic living donor nephrectomy in Italy: a national profile. Transplant Proc 36:460–463. doi:10.1016/j.transproceed.2004.02.070

    Article  CAS  PubMed  Google Scholar 

  22. Pietrabissa A, Moretto C, Carobbi A, Boggi U, Ghilli M, Mosca F (2002) Hand-assisted laparoscopic low anterior resection: initial experience with a new procedure. Surg Endosc 16:431–435. doi:10.1007/s00464-001-9084-8

    Article  CAS  PubMed  Google Scholar 

  23. Pietrabissa A, Moretto C, Boggi U, Di Candio G, Mosca F (2004) Laparoscopic distal pancreatectomy: are we ready for a standardized technique? Semin Laparosc Surg 11:179–183. doi:10.1177/107155170401100307

    PubMed  Google Scholar 

  24. Boggi U, Del Chiaro M, Croce C, Vistoli F, Signori S, Moretto C, Amorese G, Mazzeo S, Cappelli C, Campani D, Mosca F (2009) Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery 146:869–881. doi:10.1016/j.surg.2009.04.029

    Article  PubMed  Google Scholar 

  25. Ramacciato G, Nigri G, Petrucciani N, Pinna AD, Ravaioli M, Jovine E, Minni F, Grazi GL, Chirletti P, Tisone G, Napoli N, Boggi U (2016) Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients. Ann Surg Oncol 23:2028–2037. doi:10.1245/s10434-016-5123-5

    Article  PubMed  Google Scholar 

  26. Boggi U, Palladino S, Massimetti G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Amorese G, Mosca F (2015) Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study. Surg Endosc 29:1425–1432. doi:10.1007/s00464-014-3819-9

    Article  PubMed  Google Scholar 

  27. Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA (2012) “Artery-first” approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035. doi:10.1002/bjs.8763

    Article  CAS  PubMed  Google Scholar 

  28. Hackert T, Weitz J, Büchler MW (2015) Reinsertion of the gastric coronary vein to avoid venous gastric congestion in pancreatic surgery. HPB (Oxford) 17:368–370. doi:10.1111/hpb.12321

    Article  Google Scholar 

  29. Shukla PJ, Barreto G, Pandey D, Kanitkar G, Nadkarni MS, Neve R, Shrikhande SV (2007) Modification in the technique of pancreaticoduodenectomy: supracolic division of jejunum to facilitate uncinate process dissection. Hepato-Gastroenterology 54:1728–1730

    CAS  PubMed  Google Scholar 

  30. Hackert T, Büchler MW (2011) An innovative technique for pancreatic head resection: the “uncinate first” approach. Surg Technol Int 21:92–96

    PubMed  Google Scholar 

  31. Kuroki T, Tajima Y, Kitasato A, Adachi T, Kanematsu T (2010) Pancreas-hanging maneuver in laparoscopic pancreaticoduodenectomy: a new technique for the safe resection of the pancreas head. Surg Endosc 24:1781–1783. doi:10.1007/s00464-009-0814-7

    Article  PubMed  Google Scholar 

  32. Huang CK, Lo CH, Asim S, Houng JY, Huang SF (2011) A novel technique for liver retraction in laparoscopic bariatric surgery. Obes Surg 21:676–679. doi:10.1007/s11695-010-0191-2

    Article  PubMed  Google Scholar 

  33. Cusack JC Jr, Fuhrman GM, Lee JE, Evans DB (1994) Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 168:352–354. doi:10.1016/S0002-9610(05)80164-3

    Article  PubMed  Google Scholar 

  34. Hirono S, Kawai M, Tani M, Okada K, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H (2014) Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbeck's Arch Surg 399:461–471. doi:10.1007/s00423-014-1182-x

    Article  Google Scholar 

  35. Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2007) Redefining the R1 resection in pancreatic cancer. Br J Surg 93:1232–1237. doi:10.1002/bjs.5738

    Article  Google Scholar 

  36. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on PancreaticFistulaDefinition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13. doi:10.1016/j.surg.2005.05.001

    Article  PubMed  Google Scholar 

  37. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768. doi:10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  38. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25. doi:10.1016/j.surg.2007.02.001

    Article  PubMed  Google Scholar 

  39. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. doi:10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  40. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7. doi:10.1097/SLA.0b013e318296c732

    Article  PubMed  Google Scholar 

  41. Song KB, Kim SC, Hwang DW, Lee JH, Lee DJ, Lee JW, Park KM, Lee YJ (2015) Matched case-control analysis comparing laparoscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors. Ann Surg 262:146–155. doi:10.1097/SLA.0000000000001079

    Article  PubMed  Google Scholar 

  42. Meunier A, Petersson A, Good L, Berlin G (2008) Validation of a haemoglobin dilution method for estimation of blood loss. Vox Sang 95:120–124. doi:10.1111/j.1423-0410.2008.01071.x

    Article  CAS  PubMed  Google Scholar 

  43. Giulianotti PC, Addeo P, Buchs NC, Ayloo SM, Bianco FM (2011) Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas 40:1264–1270. doi:10.1097/MPA.0b013e318220e3a4

    Article  PubMed  Google Scholar 

  44. Chen S, Chen JZ, Zhan Q, Deng XX, Shen BY, Peng CH, Li HW (2015) Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29:3698–3711. doi:10.1007/s00464-015-4140-y

    Article  PubMed  Google Scholar 

  45. Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, Madura JA, Wiebke EA, Lillemoe KD (2006) A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 10:1338–1345. doi:10.1016/j.gassur.2006.09.008

    Article  PubMed  Google Scholar 

  46. Liao CH, Wu YT, Liu YY, Wang SY, Kang SC, Yeh CN, Yeh TS (2016) Systemic review of the feasibility and advantage of minimally invasive pancreaticoduodenectomy. World J Surg 40:1218–1225. doi:10.1007/s00268-016-3433-1

    Article  PubMed  Google Scholar 

  47. Napoli N, Kauffmann EF, Palmeri M, Miccoli M, Costa F, Vistoli F, Amorese G, Boggi U (2016) The learning curve in robotic pancreaticoduodenectomy. Dig Surg 33:299–307. doi:10.1159/000445015

    Article  CAS  PubMed  Google Scholar 

  48. Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657. doi:10.1007/s00464-009-0825-4

    Article  PubMed  Google Scholar 

  49. Parisi A, Desiderio J, Trastulli S, Cirocchi R, Renzi C, Boselli C, De Santis F, Petrina A, Annecchiarico M, Di Marino M, Bencini L, Perna F, Pironi D, Santoro A, Coratti A (2015) Robotic pylorus-preserving pancreaticoduodenectomy: technical considerations. Int J Surg 21(Suppl 1):S59–S63. doi:10.1016/j.ijsu.2015.06.061

    Article  PubMed  Google Scholar 

  50. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258:554–559. doi:10.1097/SLA.0b013e3182a4e87c

    PubMed  PubMed Central  Google Scholar 

  51. Piedimonte S, Wang Y, Bergman S, Vanounou T (2015) Early experience with robotic pancreatic surgery in a Canadian institution. Can J Surg 58:394–401. doi:10.1503/cjs.003815

    Article  PubMed  PubMed Central  Google Scholar 

  52. Gall TM, Jacob J, Frampton AE, Krell J, Kyriakides C, Castellano L, Stebbing J, Jiao LR (2014) Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer. JAMA Surg 149:482–485. doi:10.1001/jamasurg.2013.3643

    Article  PubMed  Google Scholar 

  53. Kuroki T, Eguchi S (2016) No-touch isolation techniques for pancreatic cancer. Surg Today. doi:10.1007/s00595-016-1317-5

    Google Scholar 

  54. Emam TA, Cuschieri A (2003) How safe is high-power ultrasonic dissection? Ann Surg 237:186–191

    PubMed  PubMed Central  Google Scholar 

  55. Uzunoglu FG, Stehr A, Fink JA, Vettorazzi E, Koenig A, Gawad KA, Vashist YK, Kutup A, Mann O, Gavazzi F, Zerbi A, Bassi C, Dervenis C, Montorsi M, Bockhorn M, Izbicki JR (2012) Ultrasonic dissection versus conventional dissection techniques in pancreatic surgery: a randomized multicentre study. Ann Surg 256:675–679 . doi:10.1097/SLA.0b013e318271cefadiscussion 679-680

    Article  PubMed  Google Scholar 

  56. Diks J, Nio D, Linsen MA, Rauwerda JA, Wisselink W (2007) Suture damage during robot-assisted vascular surgery: is it an issue? Surg Laparosc Endosc Percutan Tech 17:524–527. doi:10.1097/SLE.0b013e318150e590

    Article  PubMed  Google Scholar 

  57. Ricchiuti D, Cerone J, Shie S, Jetley A, Noe D, Kovacik M (2010) Diminished suture strength after robotic needle driver manipulation. J Endourol 24:1509–1513. doi:10.1089/end.2009.0573

    Article  PubMed  Google Scholar 

  58. Pilgrim CH, Tsai S, Tolat P, Patel P, Rilling W, Evans DB, Christians KK (2014) Optimal management of the splenic vein at the time of venous resection for pancreatic cancer: importance of the inferior mesenteric vein. J Gastrointest Surg 18:917–921. doi:10.1007/s11605-013-2428-6

    Article  PubMed  Google Scholar 

  59. Strasberg SM, Bhalla S, Sanchez LA, Linehan DC (2011) Pattern of venous collateral development after splenic vein occlusion in an extended Whipple procedure: comparison with collateral vein pattern in cases of sinistral portal hypertension. J Gastrointest Surg 15:2070–2079. doi:10.1007/s11605-011-1673-9

    Article  PubMed  Google Scholar 

  60. Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402. doi:10.1007/s00464-012-2207-6

    Article  CAS  PubMed  Google Scholar 

  61. Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R (2015) European Association of Endoscopic Surgeons. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 29:253–288. doi:10.1007/s00464-014-3916-9

    Article  PubMed  Google Scholar 

Download references

Authors’ contributions

Emanuele F Kauffmann and Niccolò Napoli collected the institutional data, analyzed institutional data, participated during surgery (assistant surgeon at the table), and reviewed the manuscript. Francesca Menonna collected literature data, analyzed literature data, participated to surgery (assistant surgeon at the table), and reviewed the manuscript. Fabio Vistoli participated in many procedures (surgeon at the table), analyzed literature data, and reviewed the manuscript. Gabriella Amorese assessed physiologic risk profile of surgical patients, provided intensive and sub-intensive post-operative care, and reviewed the manuscript. Daniela Campani and Luca Emanuele Pollina assessed specimen pathology and reviewed the manuscript. Niccola Funel conceived the method for fixation of vein segments, collected pathology data, and reviewed the manuscript. Carla Cappelli defined tumour staging and assessed individual vascular anatomy on computed tomography scans and reviewed the manuscript. Davide Caramella defined tumour staging and assessed individual vascular anatomy on computed tomography scans, interpreted data, and reviewed the manuscript. Ugo Boggi conceived and developed the robotic procedure, performed all the robotic procedures (surgeon at the console), and wrote the manuscript.

Author information

Authors and Affiliations

  1. Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy

    Emanuele F. Kauffmann, Niccolò Napoli, Francesca Menonna, Fabio Vistoli & Ugo Boggi

  2. Division of Anesthesia and Intensive Care, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Gabriella Amorese

  3. Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Daniela Campani, Luca Emanuele Pollina & Niccola Funel

  4. Division of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Carla Cappelli & Davide Caramella

Authors
  1. Emanuele F. Kauffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niccolò Napoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesca Menonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabio Vistoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gabriella Amorese
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniela Campani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luca Emanuele Pollina
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Niccola Funel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carla Cappelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Davide Caramella
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ugo Boggi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ugo Boggi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kauffmann, E.F., Napoli, N., Menonna, F. et al. Robotic pancreatoduodenectomy with vascular resection. Langenbecks Arch Surg 401, 1111–1122 (2016). https://doi.org/10.1007/s00423-016-1499-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1499-8

Keywords

Search

Navigation