THE USE OF THE NEW ENDOWRIST VESSEL SEALER EXTEND AND THE DA VINCI TABLE MOTION FOR THE DA VINCI XI IN PANCREATO-DUODENECTOMY

Background: The new technologies of da Vinci Xi system can facilitate minimally invasive surgery in challenging abdominal procedures such as pancreato-duodenectomy, making them easier and faster. We present a case of pancreatic neuroendocrine tumor (pNET) of the head of the pancreas treated with robotic Whipple procedure with the da Vinci Xi platform. Methodology: A 76-years old man with a finding of a pNET of the head of the pancreas, underwent a robot-assisted pancreato-duodenectomy with the use of the new EndoWrist Vessel Sealer Extend and the da Vinci-Integrated Table Motion (dVTM) for the Xi system. Patient was placed in a lithotomy position. Robotic trocars were placed on the transverse umbilical line. Results: The Whipple procedure was successfully completed in 570 min. Thanks to the dVTM the patient’s position changed during the intervention to improve the exposure, with the instru- ments left inside the abdomen and without undocking the robot. The dissection of the pancreatic head from the portal vein and the section of the retroportal lamina were performed with the use of the EndoWrist Vessel Sealer device. A personal modified end-to-side pancreatojejunostomy was carried out, with 5/0 Prolene and Gore-Tex double layer suture. No intra-operative complications occurred and no conversions to laparoscopy or laparotomy were required. The postoperative course was uneventful. Conclusions: The use of the new fully wristed Vessel Sealer Extend makes easier difficult maneuvers such as the fine dissection of the pancreatic head from the portal vein and the section of the retroportal lamina, enabling an optimized approach for vessels sealing and cutting and tissue bundles. Moreover, the dVTM allows patient’s movements without undocking the system or removing instruments from the abdomen, enhancing the surgical workflow.