Robotic Pancreaticoduodenectomy

Joshua A Waters, MD, Rachel E Scott, MD, Juliana E Meyer, MD, David F Canal, MD, C. Max Schmidt, MD PhD MBA. Indiana University Department of Surgery

INTRODUCTION: Robotic surgery is a relative newcomer in the realm of pancreatic surgery. A major limitation to standard laparoscopy, in this setting, is the difficulty in performing the complex reconstruction necessary after proximal pancreatic resection. This video demonstrates a pylorus-preserving pancreaticoduodenectomy using a robotic approach.

METHODS AND PROCEDURES: With the patient in supine position, access is gained to the abdomen using an optical entry trocar via a 1 cm infra-umbilical incision. Five additional 10 mm ports are placed (3 in the right and 2 in the left hemi-abdomen). Standard laparoscopic instrumentation and optics are then used to take down the hepatic flexure of the colon and perform a Kocher Maneuver. The dissection, including division of the common bile duct, duodenum and pancreatic neck, are performed using the DaVinci S Robotic Surgical System (Intuitive Surgical Inc.) The specimen is extracted via a 2cm extension of the infraumbilical incision. Robotic end-to-side pancreaticojejunostomy, choledochojejunostomy, and duodenojejunostomy are constructed using a retrocolic isoperistaltic loop of jejunum.

RESULTS: This operation was performed for suspected intraductal papillary mucinous neoplasm (IPMN) involving the main pancreatic duct in the pancreatic head. This preoperative diagnosis was based upon symptom history, radiographic and endoscopic imaging. The patient had a margin-negative resection. Pathology confirmed a main duct involved IPMN with low grade dysplasia and no evidence of cancer. The patient had an uneventful convalescence and was discharged from the hospital to home in 5 days. At 1 month follow-up, the patient is without morbidity.

CONCLUSIONS: Robotic pancreaticoduodenectomy is a feasible method for minimally-invasive resection of pancreatic head lesions.

Session: VidTV3
Program Number: V102

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