ROBOTIC PANCREATO-DUODENECTOMY WITH THE DA VINCI XI: TIPS AND TRICKS FOR AN EASY WORK-FLOW

Background: Pancreato-duodenectomy (PD) is a demanding surgical procedure especially if performed in a minimally invasive fashion. Robotic approach can facilitate both demolitive and reconstructive phases thanks to its intrinsic advantages. We present a case of an ampullary tumor treated with a full robotic PD procedure with the aid of da Vinci Xi, underlining the critical passages that can be overcome by some improvements of this latest robotic version. Methods: A 64-years old woman with imaging finding of an ampullary neoplasia, underwent a da Vinci Xi robot-assisted PD. Patient was placed in lithotomic position and robotic trocars on the transverse umbilical line in a rectilinear fashion. Results: The procedure was successfully completed in 385 minutes. The EndoWrist Vessel Sealer Extend device was used to dissect the pancreatic head from portal vein as well as the retro portal lamina, avoiding any ligation or clips application during this delicate phase. The pancreatojejunostomy was performed using a personal modified end-to-side invaginated with 3/0 V-Loc double layer running suture. The patient was discharged on POD 7th without any complication. Conclusions: The da Vinci Xi is a dynamic and multi-quadrant system that permits to performed complex surgical interventions robotically. Full wristed Vessel Sealer Extend allows a fast and safe dissection during demolitive phase whereas the use of a personal end-to-side invagination technique of pancreato-jeujeunostomy with a double layer of running barbed suture permit to deal with this difficult anastomosis despite the absence of force feedback