Alexander S Rosemurgy, MD, Timothy Bourdeau, BS, Danielle K Craigg, MD, Sharona B Ross, MD, Jack Wecowski, MD, Iswanto Sucandy, MD. Digestive Health Institute Florida Hospital Tampa
This video is of a robotic pancreaticoduodenectomy undertaken in a 61-year-old women who presented with a diagnosis of pancreatic adenocarcinoma treated with neoadjuvant therapy. Preoperative workup included a contrast enhanced CT scan, and EGD to confirm a mass in head of pancreas. An 8 mm trocar was placed through the umbilicus for the robotic camera and two 8mm robotic ports were placed at the right and left midclavicular lines on the same level as the umbilicus. A fourth 8mm robotic port was placed at the left anterior axillary line halfway between the level of the umbilicus and the costal margin. Finally, an Advanced Access Gelport® was placed between the midclavicular line and the umbilicus and an AirSeal® Access Port at the right anterior axillary line. The operation began with lysis of adhesions. The gastrohepatic omentum was opened in a stellate fashion. The duodenum was transected just distal of the pylorus and an Kocher maneuver was undertaken. The pancreatic neck was divided and dissection continued along the uncinate process of the pancreas. A cholecystectomy was also performed during the operation and the distal common bile duct was transected. The dissection continued and the jejunum was transected using a robotic stapling device. A laparoscopic EndoCatch bag was used to extract the specimen through the Advanced Access Gelport®. Reconstruction was initiated with a single-layer hepaticojejunostomy anastomosis followed by a two-layer pancreaticojejunostomy anastomosis. A single-layer duodenojejunostomy was constructed just distal to the pylorus. Finally, a Jackson Pratt drain was placed prior to closure. The patient tolerated the operation well, and was placed on the ERAS protocol and she did not experience any operative or postoperative complications. The patient was discharged post-operative day 6.
Keywords: Robotic Surgery, Pancreaticoduodenectomy, Minimally Invasive Surgery
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95835
Program Number: V025
Presentation Session: HPB Videos
Presentation Type: Video