Robotic pancreaticoduodenectomy with preservation of totally replaced right hepatic artery coming from the superior mesenteric artery

Mario Masrur. University of Illinois

Background: The most common variation of the hepatic artery is a replaced right hepatic artery (RHA) arising from the superior mesenteric artery (SMA).  Recognition of anatomic abnormalities is fundamental during surgery, especially in complex procedures, such as pancreaticoduodenectomies. We herein report a case of robotic pancreaticoduodenectomy with preservation of a replaced RHA in a patient diagnosed with pancreatic cancer.

Case description: A 59-year-old female was referred to our department after completing neoadjuvant chemotherapy for pancreatic cancer. She had previously undergone endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) with metal stent placement in another institution. The CT scan did not pose any contraindication to surgery and the patient was offered the option of a minimally invasive treatment. A robotic pylorus-preserving pancreaticoduodenectomy was performed. Operative time was 413 minutes, including docking time. The estimated blood loss was 200ml and no blood transfusions were required. The drains were removed on postoperative day 5. The patient was discharged on postoperative day 7 without any complications.

Conclusion: The robotic system can be a valuable instrument in the hands of experienced hepatobiliary surgeons, especially in those cases that have an increased complexity, like in case of anatomical abnormalities.

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