Introduction: Walled-off pancreatic necrosis (WOPN) represents a late complication of severe acute pancreatitis, with a high mortality rate. Its management depends on the patient's symptoms and WOPN location. The da Vinci surgical systems have been developed to allow an easier mini-invasive surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using da Vinci Xi platform. Methods: A 63-years old man with acute necrotizing pancreatitis was referred to our center. The patient developed a massive fluid collection causing gastrointestinal obstruction. The CT-scan 6 weeks after the acute episode confirmed the presence of a walled-off pancreatic necrosis compressing the stomach and the first duodenal portion. The patient was surgically treated using the da Vinci Xi platform. Results: Surgery was successfully completed in 130 min. An intraoperative US-guided anterior ideal gastrotomy was first performed. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was performed with the new EndoWrist stapler. Necrosectomy and toilette were performed through the anastomosis. Finally, the anterior gastrotomy was closed with triple layer 3-0 V-Lock running suture and cholecystectomy was done. No conversion or intra-operative complications occurred and the postoperative course was uneventful. A post-operative TC scan showed the collapse of the fluid collection. Conclusions: The da Vinci Xi platform with its new robotic Endowrist stapler have been safely used in the surgical treatment of walled-off pancreatic necrosis. The Tile-Pro multi-input display consents the surgeon a 3D view of the operative field along with ultrasound exam, allowing to identify the best position where to perform the drainage.

ROBOT-ASSISTED TRANS-GASTRIC DRAINAGE AND DEBRIDMENT OF WALLED-OFF PANCREATIC NECROSIS USING THE ROBOTIC ENDOWRIST® STAPLER FOR THE DA VINCI XI®

Morelli L;Guadagni S;Furbetta N;Bianchini M;Palmeri M;Gianardi D;Di Franco G;Picchi M;Mosca F;Di Candio G
2018

Abstract

Introduction: Walled-off pancreatic necrosis (WOPN) represents a late complication of severe acute pancreatitis, with a high mortality rate. Its management depends on the patient's symptoms and WOPN location. The da Vinci surgical systems have been developed to allow an easier mini-invasive surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using da Vinci Xi platform. Methods: A 63-years old man with acute necrotizing pancreatitis was referred to our center. The patient developed a massive fluid collection causing gastrointestinal obstruction. The CT-scan 6 weeks after the acute episode confirmed the presence of a walled-off pancreatic necrosis compressing the stomach and the first duodenal portion. The patient was surgically treated using the da Vinci Xi platform. Results: Surgery was successfully completed in 130 min. An intraoperative US-guided anterior ideal gastrotomy was first performed. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was performed with the new EndoWrist stapler. Necrosectomy and toilette were performed through the anastomosis. Finally, the anterior gastrotomy was closed with triple layer 3-0 V-Lock running suture and cholecystectomy was done. No conversion or intra-operative complications occurred and the postoperative course was uneventful. A post-operative TC scan showed the collapse of the fluid collection. Conclusions: The da Vinci Xi platform with its new robotic Endowrist stapler have been safely used in the surgical treatment of walled-off pancreatic necrosis. The Tile-Pro multi-input display consents the surgeon a 3D view of the operative field along with ultrasound exam, allowing to identify the best position where to perform the drainage.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/935405
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