Roberto Bustos, MD, Valentina Valle, MD, Alberto Mangano, MD, Sam Papasotiriou, Pier C Giulianotti, MD, FACS. University of Illinois at Chicago
Introduction: Central pancreatectomy is among the techniques available for the treatment of pancreatic neck tumors. It is indicated for benign or low-grade malignant neoplasms. This pancreas-sparing technique was developed to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient’s quality of life. Robotic central pancreatic resection has been used increasingly used since the first report in 2004 by our team. However, patients who require central pancreatectomy are often still treated by open or laparoscopic distal pancreatectomy.
Methods and procedures: 46-year-old female. PMH: diabetes mellitus, hypertension, dyslipidemia, obesity and hypersensitivity lung disease. HPI: episodic sharp abdominal pain radiated to the back and started 3 months before. CT scan: cystic lesion at the pancreatic head/neck junction (3.2×6.6×3.2 cm). EUS-FNA: suspicious for intraductal papillary mucinous neoplasm. Blood tests: elevated amylase and CEA.
Results: Surgical procedure: robotic laparoscopic central pancreatectomy with distal pancreaticogastrostomy. During the preparation of the pancreatic neck, inflammatory adhesions of the mucinous cyst to the portal vein had to be carefully dissected by microscissors. After the pancreatic parenchyma was divided, intraoperative frozen pathology reported no malignancy or severe dysplasia. Decision was taken to preserve the distal pancreas and also the pancreatic head in order to decrease the risk of endocrine/exocrine insufficiency. An end-to-side pancreaticogastrostomy was performed using a PDS 3-0 running suture posteriorly and interrupted PDS 3-0 stitches anteriorly. Post operatory course was uneventful. Patient discharged on POD7. No pain or steatorrhea after 1 month follow up. Pathology report: IgG4-related disease, associated with cystic formation negative for PanIN and carcinoma.
Conclusions: Robotic central pancreatic resection is a safe and feasible approach which can avoid endocrine/exocrine insufficiency (in particular for benign/low-grade malignant neoplasms). The Robotic platform, given the improved dexterity, the 3D stereotactic vision, and the better tissue manipulation, if used with a standardized technique in high expertise centers can be advantageous (in particular when adhesions are present).
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93944
Program Number: V242
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop