Abstract
Abstract
Introduction:
Robotics are increasingly used for major hepato-pancreato-biliary (HPB) surgery. In this study, a case is presented of fully robotic Whipple's procedure for neuroendocrine tumor of the pancreatic head. Our institution is an ENETS center of excellence with a high yearly case load of HPB procedures, and a longstanding and extensive program in robotic surgery for endocrine and GI procedures. Hence, all our “noncomplex” Whipple cases are considered for robotic approach.
Patient:
A 40 years old female patient with a body mass index of 27.3 kg/m2 and a medical history of conservatively treated splenic rupture was referred with atypical abdominal complaints. On computed tomography (CT) scan, a hypervascular mass was found in the head of the pancreas, which displayed marked avidity on Gallium-68 Dotatate-PET/CT. There was distinct portal vein indentation but no signs of ingrowth. No metastases were seen.
Results:
The video displays the consecutive steps involved in the fully robotic Whipple procedure. Four robot ports and two assistant ports were used, as well as one 5 mm port for retraction of the liver. The freedom of movement of the robot arms was found to be particularly useful during the dissection of the structures in the hepatoduodenal ligament, and for the construction of the pancreaticojejunostomy and hepticojejunostomy. The procedure took 5.5 hours, blood loss was minimal. The postoperative course was uneventful except for transient chyle leakage that was treated conservatively. Histology analysis revealed a 3.5 cm pNET grade 2, N0, R0.
Conclusion:
This case illustrates the increased dexterity and visibility of using robot assistance during minimally invasive pancreaticoduodenectomy for pancreatic NET. This approach is feasible and safe, and particularly suited for “difficult” anastomoses in case of soft pancreas and nondilated ducts.
We have had NO commercial associations during the past two years that might create a conflict of interest in connection with the video. I.Q.M. and J.H. are proctors in robotic HPB surgery for intuitive surgical. There are no other disclosures.
Runtime of video: 12:00 mins 00 secs
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