WALLED-OFF PANCREATIC NECROSIS: DRENAGGIO E DEBRIDMENT TRANS- GASTRICO ROBOTICO CON SISTEMA DA VINCI XI E SUTURATRICE ROBOTICA

Introduction: Among the possible late complications of severe acute pancreatitis, walled-off pancreatic necrosis (WOPN) can be found. WOPN have a high mortality rate and its management depends on the location and the patient's symptoms. The da Vinci surgical systems allow an easier mini-invasive surgery, also in challenging abdominal procedures. Here, we report a case of a man with a WOPN undergoing 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 gastrointestinal obstruction associate with an abdominal massive fluid collection. 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 surgical system. Results: Operating time was 130 min. At first, an intraoperative US-guided gastrotomy was performed on the anterior gastric wall. Through the gastrotomy, the ideal location for drainage on the posterior gastric wall was US-guided identified, and the anastomosis between the walled-off necrosis wall and the posterior gastric wall was performed with the new EndoWrist stapler. Necrosectomy and toilette were performed through the anastomosis. Finally, a triple layer 3-0 V-Lock running suture was performed to close the anterior gastric breach and cholecystectomy was done. No surgical complications occurred during the intervention and the postoperative stay and no conversion to laparotomy trocars was required. 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 robotic trans-gastric drainage of walled-off pancreatic necrosis. The Tile-Pro multi-input display allows the surgeon a 3D view of the operative field along with ultrasound exam to identify the best position where to perform the drainage.