ROBOT-ASSISTED APPLEBY PANCREATECTOMY WITH THE DA VINCI XI FOR A LOCALLY ADVANCED CANCER

Aims: The new da Vinci Xi surgical cart allows multi-quadrant and complex surgical inter- ventions in a minimally invasive fashion. We present a case of robotic Appleby left pancreatectomy using this platform and its specific operating bed. Methods: A 73-years old woman with CT scan finding of a 30-mm hypo-vascular neoplasm of the pancreas body underwent surgery with the use of the new da Vinci Xi with four arms upper quadrants trocar’ disposition. Results: The procedure was successfully completed in 285 min. The pancreatic body was mobilized in order to expose the portal-mesenteric axis. The gland was transected using a robotic endo-stapler as well as the splenic vein. After evaluating the patency of collateral circles with intra-operative ultrasound, the common hepatic artery and the celiac artery were transected. Then we increased the right tilted position and the neoplasia was detached from the gastric body by a tangential gastric resection using the robotic endo-stapler. Finally, the operation was accom- plished with the transection of the posterior attachment of the spleen and the pancreatic tail. No conversion or intra-operative complications were recorded. The post-operative course was uneventful and the patient was discharged 6 days after surgery. Conclusions: The da Vinci Xi with its specific tools helps in performing challenging procedures such as Appleby operation for locally advanced pancreatic cancer. In our experience, the robotic endo-stapler permits the operating surgeon to directly control the transaction phase whereas the specific operating bed allows to perform minimally invasive multi-quadrant surgery and to obtain a better exposition of the operating field.