LF Gonzalez Ciccarelli, MD, R Bustos, MD, M Masrur, S Gruessner, V Valle, F Bianco, P Giulianotti. University of Illinois at Chicago
Introduction: Whipple procedures are one the most challenging surgeries due to the pancreas location and vascular relations. Bleeding control can be a difficult task to overcome leading to increased blood losses and conversion.
Methods Procedures and Result: Patient is a 43 year old female with a PMH of DM and heroin abuse. Patient presented to OSH ER with withdrawal symptoms. CT scan was performed at OSH showed pancreatic cyst, the patient was referred to this institution for higher hospital care. EUS + FNA showed 6.1 x 4.7 cm mass, septate cystic lesion in the pancreatic body. Pathology showed a +ve mucin with BF CEA 4,039 and amylase of 262. CT scan showeda 6,8 x 4,9 x 4,8 cm transverse hypo attenuating lesion arising from pancreatic body with a thick circumferential wall. Inferior aspect of the mass abuts the splenic artery without narrowing. Medial portion involves the portal vein confluence with less than 90 degrees involvement with multiple splenic varices in the LUQ, suggest compression of the splenic vein by pancreatic mass.The patient was elected to undergo a robot-assisted distal spleno-pancreatectomy.Operative time was 282 minutes, overall estimated blood loss was 150 ml. No blood transfusions were necessary. The pathology report was consistent with mucinous cystic tumor 9.1 x 8.9 x 4.5cm. The resection margins were negative with 11/11 negative lymph nodes. There were no intra or postoperative complications. On POD1 amylase 1435 with sudden drop to 46 at POD2 and 15 at discharge. The patient was discharged from the hospital on postoperative day 7. Four month follow-up patient is asymptomatic with no complains.
Conclusion: The robotic system has the potential to increase the safety of the procedure, facilitating the management of intraoperative bleedings with endowristed instruments and selective sutures, reducing overall blood loss and risk of conversion when compared to standard laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95683
Program Number: V354
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop