Subhashini Ayloo, MD, MPH, Jacob Schwartzman, MD. Rutgers, New Jersey Medical School
Objective: To demonstrate the safety and feasibility of robot-assisted subtotal pancreatectomy and splenectomy in posterior pancreatic lesions.
Materials & Methods: A 43 year-old woman with symptoms of sweating, dizziness, hypoglycemia, is found on diagnostic imaging to have a large mass in the body/tail of pancreas with solid and cystic components.
This video showcases the fine technical details of a minimal invasive approach to subtotal pancreatectomy. The pancreas was exposed by transecting the gastrocolic ligament and retracting the stomach cranially with the 4th arm of the robot. The lesion was large, posteriorly located in the distal pancreas, extending inferiorly, and capsulated.The splenic flexure was taken down. About 2 cm proximal to the lesion, close to the portal vein, the pancreatic transection site was marked and a tunnel was created behind the pancreas starting from inferior border. The splenic artery is dissected and controlled. The pancreatic body was transected with an endo-GIA and medial to lateral dissection of the pancreas including splenectomy was performed. The specimen is extracted via a Pfannensteil incision.
Conclusions: Robot-assisted subtotal pancreatectomy and splenectomy is safe and feasible. The Da Vinci system provides a stable platform with 3-D visualization and improved ergonomics, which facilitate removal of large lesions that are located posteriorly and inferiorly on the pancreas.
Educational/Technical Points: The camera is positioned left mid-abdomen, with the left and right arms of the surgeon on either side. The robotic 4th arm is placed in a right lateral position, and a first assistant port is placed inferomedial to the surgeon’s left arm. The 4th arm of the robot has a multifunctional purpose in retracting the left lateral segment of liver and in retracting the stomach to expose the pancreas.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92376
Program Number: V374
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop