ROBOTIC PANCREATO-DUODENECTOMY WITH THE USE OF THE NEW ENDO-WRIST VESSEL SEALER EXTEND AND THE DA VINCI TABLE MOTION FOR XI

Background: The da Vinci Xi system with its new technologies allows an easier and faster minimally invasive surgery also in challenging abdominal procedures such as pancreato-duodenectomy. We present a case of pancreatic neuroendocrine tumor (pNET) of the head of the pancreas treated with robotic Whipple procedure with da Vinci Xi platform. Methodology: A 76-years old man with a finding of a pNET of the head of the pancreas, underwent a pancreato-duodenectomy with the use of the new EndoWrist Vessel Sealer Extend and the da Vinci-Integrated Table Motion (dV-ITM) for 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 minutes. Thanks to the dV-ITM the patient’s position changed during the intervention to improve exposure with instruments 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 enhanced surgical dexterity offered by da Vinci Xi robotic system facilitates to perform complex procedures such as pancreato-duodenectomy by a minimally invasive approach. The fully wristed EndoWrist Vessel Sealer enables an optimizes approach for vessels sealing and cutting and tissue bundles even in difficult maneuvers such as dissection of the pancreatic head from the portal vein and section of the retroportal lamina. Moreover, the dV-ITM allows patient’s movements without undocking the system or removing instruments from the abdomen, reducing surgical time and improving the fluidity of the surgical workflow.