Real robotic total mesopancreas excision (TMpE) assisted by hanging manoeuver (HM): Standardised technique

Abstract

Background Pancreaticoduodenectomy (PD) is one of the most demanding interventions for digestive surgeons. R0 resection is a key point for the overall survival and disease‐free survival. Total mesopancreas excision (TMpE) has been described by laparotomy but laparoscopy did not provide good results probably because of the technical difficulties of the approach. We propose a standardised total robotic approach. Methods In this step‐by‐step technical description, we propose as example, a case of a 53‐year‐old man with a pancreatic head adenocarcinoma with doubts about the invasion of the mesopancreas surrounding superior mesenteric artery. The mesopancreas hanging manoeuver allows us to perform a TMpE. Results The surgery performed was a robotic artery first pancreaticoduodenectomy with TMpE. The pathological result was pancreatic ductal adenocarcinoma pT2, N1 (1/23), M0, V0, L0, Pn0, R0. Conclusions Robotic approach is safe, effective and reproductible. Through a standardised technique, it may overcome some of the technical difficulties of laparoscopic PD.