Aims: Robotic technology can facilitate challenging minimally invasive procedures such as pancreato-duodenectomy (PD). We present a case of full robotic Traverso-Longmire (T-L) procedure, reporting some tips and tricks to simplify the workflow. Methods: A 64-years old woman with an ampullary neoplasia underwent robotic PD with da Vinci Xi system. Patient was placed in lithotomic position and robotic trocars on the transverse umbilical line. Results: The main bile duct was sectioned only after a clip application to avoid a bile leakage staining the operative field. After Kocher maneuver, we continued the dissection to the right side until Treitz liberation to reduce the risk of intestinal loop malrotation during its retro mesenteric transposition. The dissection was performed with the EndoWrist Vessel Sealer Extend device, even the dissection of the pancreatic head from the portal vein and of retro portal lamina, avoiding any ligation or clip application. Pancreatojejunostomy was performed with a personal modified end-to-side invaginated 3/0 V-Loc double layer running suture. The procedure was completed in 385 minutes, no intra- or post-operative complications occurred. The patient was discharged on POD 7th. Conclusions: The da Vinci Xi allows to perform challenging procedures like PD with a minimally invasive technique. We suggested some tips and tricks like Treitz liberation by the right side to minimize the risk of malrotation of the anastomotic loop, the use of fully wristed Vessel Sealer Extend and a personal end-to-side invaginated technique of pancreato-jeujeunostomy to fasten and simplify the surgical workflow.

ROBOT ASSISTED PANCREATO-DUODENECTOMY: TIPS AND TRICKS FOR AN EASY AND FAST WORKFLOW

Gianardi D;Palmeri M;Furbetta N;Bianchini M;Guadagni S;Di Franco G;Fatucchi LM;Cappelli G;Di Candio G;Morelli L
2020-01-01

Abstract

Aims: Robotic technology can facilitate challenging minimally invasive procedures such as pancreato-duodenectomy (PD). We present a case of full robotic Traverso-Longmire (T-L) procedure, reporting some tips and tricks to simplify the workflow. Methods: A 64-years old woman with an ampullary neoplasia underwent robotic PD with da Vinci Xi system. Patient was placed in lithotomic position and robotic trocars on the transverse umbilical line. Results: The main bile duct was sectioned only after a clip application to avoid a bile leakage staining the operative field. After Kocher maneuver, we continued the dissection to the right side until Treitz liberation to reduce the risk of intestinal loop malrotation during its retro mesenteric transposition. The dissection was performed with the EndoWrist Vessel Sealer Extend device, even the dissection of the pancreatic head from the portal vein and of retro portal lamina, avoiding any ligation or clip application. Pancreatojejunostomy was performed with a personal modified end-to-side invaginated 3/0 V-Loc double layer running suture. The procedure was completed in 385 minutes, no intra- or post-operative complications occurred. The patient was discharged on POD 7th. Conclusions: The da Vinci Xi allows to perform challenging procedures like PD with a minimally invasive technique. We suggested some tips and tricks like Treitz liberation by the right side to minimize the risk of malrotation of the anastomotic loop, the use of fully wristed Vessel Sealer Extend and a personal end-to-side invaginated technique of pancreato-jeujeunostomy to fasten and simplify the surgical workflow.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1066043
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