Robot Assisted Trans-Gastric Drainage of Walled-Off Pancreatic Necrosis with Robotic Endowrist Stapler for the Da Vinci XI

Aim: Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatits. The mortality rate with WOPN is high but less than infected pancreatic necrosis. Management depends on the patient's symptoms and the location of the WOPN. The da Vinci surgical System has been developed to allow an easy, mini-invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a trans-gastric drainage using the da Vinci Xi. Methods: A 63-years old man with an episode of acute necrotizing pancreatitis was referred to our center. The patient developed a massive fluid collection determinates obstruction of the gastrointestinal tract and the TC-scan, performed 6 weeks after the acute episode, confirmed the presence of a walled-off pancreatic necrosis that compresses the stomach and the first duodenal portion. The patient was operated with the use of the da Vinci Xi surgical system. Results: The procedure was successfully completed in 130 min. Firstly, guided by intraoperative ultrasound, was performed an anterior ideal gastrotomy. Then, through the gastrotomy, the best location on the posterior gastric wall for drainage was again US-identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler. Necrosectomy and washing of the cavity through the anastomosis was performed. Finally, the anterior gastrotomy was closed with three layers of 3-0 V-Lock running sutures and the cholecystectomy was performed. No conversion or intra-operative complications were recorded. The postoperative course was uneventful and a post-operative TC scan showed the collapse of the fluid collection. Conclusions: In this case the da Vinci Surgical System has been safely used in the surgical treatment of walled-off necrosis. The Tile-Pro multi-input display consent the surgeon to view 3D video of the operative field along with ultrasound exam, allows to identify the best location where perform the drainage. Furthermore the enhanced surgical dexterity could give some advantages by facilitating the sutures.