Robotic total pancreatectomy with splenectomy for multifocal intraductal papillary mucinous neoplasm

Abstract

Objective: Management of post-pancreatitis peripancreatic fluid collections depends on the size, location, and contents of the collection as well as any associated symptoms. The amount of time elapsed after acute pancreatitis is also considered in international consensus guidelines. With increased surgeon experience in minimally invasive approaches, many techniques for laparoscopic treatment of these collections have been described. Advances in endoscopic modalities also allows many perigastric and periduodenal collections to be treated endoscopically. Rates of recurrence, repeat intervention, and procedural morbidity are considered in reviews comparing open, laparoscopic, and endoscopic approaches. We present a case of walledoff pancreatic necrosis (WOPN) treated with robotic cystgastrostomy and pancreatic debridement. Methods: A robotic cystgastrostomy was performed in a patient who developed WOPN after acute biliary pancreatisis. Key features differentiating this procedure from laparoscopic transgastric approaches include the size of the anterior gastrotomy, the use of hand-sewn technique to mature the cystgastrostomy, and no routine use of stapling devices. Results: The patient was discharged on postoperative day 4. Her follow-up imaging demonstrated resolution of the WOPN. Conclusion: Use of the surgical robot confers many benefits of minimally invasive surgery to the treatment of postacute pancreatic fluid collections while utilizing technical features of the procedure described in the open approach. Longitudinal analysis is needed to determine if the robotic approach affects surgical outcomes, rate of fluid collection resolution, or occurrence of complications. V12LAPAROSCOPIC CENTRAL PANCREATECTOMY WITH ROUX-EN-Y PANCREATOJEJUNOSTOMY Objective: Central pancreatectomy is an alternative technique for benign or low-grade malignant tumors of the neck of the pancreas. The objective is to present a video of a laparoscopic central pancreatectomy Methods: A 48-year-old woman with a 2.5 cm incidental cystic tumor in the neck of the pancreas is referred. Pancreas is transected with an endoscopic linear stapler on the right side of the tumor followed by transection of the distal pancreas. After completion of pancreatic resection, Roux-en-Y jejunal loop is prepared. An end-to-side pancreatojejunostomy is then performed in a double layer technique duct-to-mucosa. Results: Operative time was 4 hours with minimum blood loss. Patients was discharged on the 4th postoperative day.Patient developed a type A pancreatic fistula that was treated by late removal of the drain. Pathology confirmed a mucinous cystadenoma with no malignant transformation. Patient did not develop exocrine or endocrine pancreatic insufficiency on late follow-up. Conclusion: Totally laparoscopic central pancreatectomy is feasible and it is a useful technique for removal of tumors located in the neck of the pancreas. Objective: Radical antegrade modular pancreatosplenectomy, originally proposed by Strasberg, has been accepted as a standard operation fo...