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Reproduction of modified Blumgart pancreaticojejunostomy in a robotic environment: a simple clipless technique

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Abstract

Background

Although modified Blumgart anastomosis (MBA) in robotic pancreaticoduodenectomy has been accepted as a simple and safe procedure that provides non-inferior surgical outcomes compared to open MBA, the details of the standardization of robotic MBAs have never been established. In this report, we detail the technical tips to reproduce MBA in the robotic environment.

Materials and methods

From January to December in 2021, 16 patients underwent our novel robotic MBA technique, which included clipless Blumgart suture and duct-to-mucosa anastomosis. To simplify the manipulation of sutures in robotic environment, short double-armed sutures in 15 cm length were created and used for Blumgart suture. Duct-to-mucosa anastomosis were done by 5-0 monofilament of 6 cm length. These tips enabled clipless anastomosis and minimized the burden of the patient-side assistant. Surgical and short-term outcomes were compared between patients with robotic MBA (Robo group) and those who underwent open MBA during 2021 (32 patients, Open group).

Results

The median operation time was significantly longer in the Robo group than in the Open group (551 vs. 485.5 min, P = 0.0027). Estimated blood loss was significantly lower in the Robo group than in the open group (95 vs. 355 mL, P < 0.0002). The median duration of clipless MBA in the Robo group was 56 (46–68) min. The incidence of POPF (grade B or C) was not significantly different among the groups (19% vs. 22%, P = 0.71). The mean length of hospital stay was significantly shorter in the Robo group than in the Open group (18 vs. 24 days, P = 0.019).

Conclusion

Clipless MBA in a robotic environment was safely performed with acceptable short-term outcomes and can be proposed as a standard technique for robotic pancreatojejunostomy.

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Abbreviations

MBA:

Modified Blumgart anastomosis

MPD:

Main pancreatic duct

PJ:

Pancreatojejunostomy

POPF:

Postoperative pancreatic fistula

RPD:

Robotic pancreaticoduodenectomy

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Acknowledgements

We thank professor Yi-Ming Shyr and professor Shin-E Wang, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, for the valuable teaching of fundamental techniques of robotic pancreatectomy and the inspiration of this study.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yosuke Inoue, Takafumi Sato, Tomotaka Kato, Atsushi Oba, Yoshihiro Ono, Yoshihiro Mise, Hiromichi Ito & Yu Takahashi

  2. Department of Hepatobiliary Pancreatic Surgery, Juntendo University Hospital, Tokyo, Japan

    Yoshihiro Mise

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  1. Yosuke Inoue
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  2. Takafumi Sato
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  3. Tomotaka Kato
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  4. Atsushi Oba
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  5. Yoshihiro Ono
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  6. Yoshihiro Mise
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  7. Hiromichi Ito
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  8. Yu Takahashi
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Correspondence to Yosuke Inoue.

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Drs. Yosuke Inoue, Takafumi Sato, Tomotaka Kato, Atsushi Oba, Yoshihiro Ono, Yoshihiro Mise, Hiromichi Ito, and Yu Takahashi have no conflicts of interest or financial ties to disclose.

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Inoue, Y., Sato, T., Kato, T. et al. Reproduction of modified Blumgart pancreaticojejunostomy in a robotic environment: a simple clipless technique. Surg Endosc 36, 8684–8689 (2022). https://doi.org/10.1007/s00464-022-09397-2

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  • DOI: https://doi.org/10.1007/s00464-022-09397-2

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