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Robotic Whipple Operation Technique

Deniz Atasoy, Afag Aghayeva, Volkan Ozben, Turgut Bora Cengiz, Onur Bayraktar, Ismail Hamzaoglu, Tayfun Karahasanoglu, Bilgi Baca. Acibadem Mehmet Ali Aydinlar University, School of Medicine

Introduction: Whipple operation is a technically demanding procedure. Laparoscopic approach has some limitations further complicating the operation. These could be the reasons in front of generalization of the laparoscopic Whipple procedure. The procedure itself is commenced around great vessels of the abdomen. Therefore, any limitations of the instruments may cause fatal injuries. Robotic platform, changed the paradigm of surgery by transforming it into a console-surgery. Rigid instruments with limited range of motion, unstable retraction and assistant-dependent visualization is overcome by the robotic platform. In addition, tremor filtration feature enables fine and delicate dissection around small structures like vessel tributaries, bile ducts and pancreatic channel. Robotic platform with its promoted benefits may ease minimally invasive Whipple operation. How will these features translate into perioperative outcomes are to be addressed? Herein, we aimed to present our technique of robotic Whipple procedure for pancreatic head cancer.

Methods: A 30-year old female patient was diagnosed with a 45-mm mass in the head of the pancreas. Endoscopic ultrasound with fine needle aspiration biopsy examination revealed a neuroendocrine tumor (NET). The patient was offered robotic Whipple surgery and written informed consent was obtained. Patient was placed in reverse Trendelenburg position with legs separated. The robot (da Vinci Xi, Intuitive Surgical Inc., Sunnyvale, CA) was mounted from the patient’s left. For the procedure, four 8-mm and one 12-mm robotic trocars, and one 5-mm assistant trocar for bedside surgeon were used. Bedside assistant stood between the patient’s leg. Single docking was sufficient during the operation.

Results: The docking and operative times were 6 min and 660 min, respectively. The estimated blood loss was 50 mL. Pathological examination of the specimen discovered two synchronous NETs, one 3.5cm Grade 2 in the uncinate process and the other 0.5cm Grade 1 in the duodenum. Postoperatively a chylous drainage was observed that subsided with conservative management. Follow-up period of 11 months was uneventful.

Conclusions: Robotic technology seems to overcome some of the technical limitations of the laparoscopic approach. According to our subjective view of experience robotic platform may ease in spread of minimally invasive pancreatic surgery.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87451

Program Number: V008

Presentation Session: Liver/Pancreas Video Session

Presentation Type: Video

74

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