Abstract
Background
Robotic surgery is the most advanced development in minimally invasive surgery. However, the number of reports on robot-assisted endoscopic gastrointestinal surgery is still very small. In this article, we describe total laparoscopic pancreaticoduodenectomy (PD) undertaken using the da Vinci Surgical System® (Intutive Surgical).
Methods
Three patients underwent robotic PD between November 2009 and February 2010. Following resection of the pancreatic head, duodenum, and the distal stomach, intracorporeal anastomosis was accomplished by Child’s method of reconstruction, which includes a two-layered end-to-side pancreaticojejunostomy, an end-to-side choledochojejunostomy, and a side-to-side gastrojejunostomy.
Results
The time required for surgery was 703 ± 141 min, and blood loss was 118 ± 72 mL. The average hospital stay period was 26 ± 12 days. As a postoperative complication, pancreatic juice leak occurred in one case, but it was managed with conservative treatment. Of the three patients, one had cancer of the papilla of Vater, one had cancer of the pancreatic head, and one had a solid pseudopapillary neoplasm. In all cases, the surgical margin was negative for tumor.
Conclusions
Robot-assisted PD required a long time, but organ removal with less bleeding was able to be safely performed owing to the high degree of freedom associated with the forceps manipulation and the magnified view. Similarly, pancreatojejunostomy could certainly be conducted. No major postoperative complications were found. Accumulation of da Vinci PD experience in the future will lead to safer and faster PD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Himpens J, Leman G, Cadiere GB. Telesurgical laparoscopic cholecystectomy. Surg Endosc. 1998;12:1091.
Boehm DH, Reichenspurner H, Gulbins H, Detter C, Meiser B, Brenner P, et al. Early experience with robotic technology for coronary artery surgery. Ann Thorac Surg. 1999;68:1542–6.
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84.
Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telemonitoring. Review of early clinical results. Surg Endosc. 2002;16:1389–402.
Horgan S, Galvani C, Gorodner V, Bareato U, Panaro F, Oberholzer J, et al. Robotic distal pancreatectomy and nephrectomy for living donor pancreas-kidney transplantation. Transplantation. 2007;84:934–6.
Horgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation. 2007;73:1474–80.
Stephenson ER, Sankholkar S, Ducko CT, Damiano JR. Robotically assisted microsurgery for endoscopic coronary artery bypass grafting. Ann Thorac Surg. 1998;66:1064–7.
Uyama I, Sugioka A, Fujita J, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999;2:230–4.
Sinohara T, Uyama I, Kanaya S, Inaba K, Isogaki J, Horiguchi A, et al. Total laparoscopic pancreaticoduodenectomy for locally advanced gastric cancer. Langenbecks Arch Surg. 2009;394:733–7.
Crricaburu E, Enezian G, Bonnard A, Berrebi D, Belarbi N, Huot O, et al. Laparoscopic distal pancreatectomy for Franz’s tumor in a child. Surg Endoscc. 2003;17:2028–31.
Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet. 2004;363:1187–92.
Hashizume M, Shimada M, Sugimachi K. Laparoscopic hepatectomy: new approach for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2000;7:270–5.
Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, et al. Laparoscopic major hepato-biliary-pancreatic surgery: formidable challenge to standardization. J Hepatobiliary Pancreat Surg. 2009;16:705–10.
Nakamura Y, Uchida E, Nomura T, Aimoto T, Matsumoto S, Tajiri T. Laparoscopic pancreatic resection: some benefits of evolving surgical techniques. J Hepatobiliary Pancreat Surg. 2009;16:741–8.
Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy. Feasibility and outcome in an early experience. Arch Surg. 2010;145:19–23.
Horiguchi A, Ishihara S, Ito M, Nagata H, Shimizu T, Furusawa K, et al. Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first. J Hepatobiliary Pancreat Surg. 2007;14:575–8.
Horiguchi A, Ishihara S, Ito M, Nagata H, Asano Y, Yamamoto T, et al. Multislice CT study of pancreatic head arterial dominance. J Hepatobiliary Pancreat Surg. 2008;15:322–6.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.
Melvin WS, Needleman BJ, Krause KR, Ellison EC. Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech. 2003;13:33–6.
Vasilescu C, Sgarbura O, Tudor S, Herlea V, Popescu I. Robotic spleen-preserving distal pancreatectomy. A case report. Acta Chir Belg. 2009;109:396–9.
Narula VK, Mikami DJ, Melvin WS. Robotic and laparoscopic pancreaticoduodenectomy. A hybrid approach. Pancreas. 2010;39:160–4.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Horiguchi, A., Uyama, I. & Miyakawa, S. Robot-assisted laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 18, 287–291 (2011). https://doi.org/10.1007/s00534-010-0325-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-010-0325-x