ROBOTIC TRANS-GASTRIC DRAINAGE AND DEBRIDMENT OF WALLED- OFF PANCREATIC NECROSIS WITH THE USE OF THE ENDOWRIST STAPLER FOR THE DA VINCI XI

Introduction: Walled-off pancreatic necrosis (WOPN) is a late complication of severe acute pancreatitis, with a high mortality rate. WOPN management depends on its location and on patient's symptoms. The da Vinci surgical systems allow an easier mini-invasive surgery, also in challenging abdominal procedures. We present a case of a WOPN treated with a robotic trans-gastric drainage and debridement with the use of the da Vinci Xi platform and its Endowrist Stapler. Methods: A 63-years old man with acute necrotizing pancreatitis was referred to our center. After a conservative management, 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 underwent surgery with the da Vinci Xi platform. Results: The procedure was successfully completed in 130 min. Firstly, an intraoperative US-guided anterior ideal gastrotomy was 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 carried out 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 were recorded and the postoperative course was uneventful. A post-operative CT scan showed the collapse of the fluid collection. Conclusions: The da Vinci Xi system 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.