A. Parisi

Pancreaticoduodenectomy is one of the most technically demanding abdominal surgeries. This video shows the use of the robotic system to perform the reconstructive phase of the whipple procedure. The “Da Vinci” robotic system allows for a wide three-dimensional field of vision, a steady traction, the suppression of physiological tremor and has flexible tools and an internal articulated EndoWrist that allows seven degrees of freedom. The surgeon feels his dexterity increased, the ability to perform a precise and advanced sutures, thus overcoming the limit of the lack of tactile feed-back and replacing it with the visual feedback. In this way, it is possible to rebuild the gastrointestinal tract with biliary, pancreatic and gastric anastomosis hand-sewn with 3-4/0 PDS.

A new post has been published on Clinical Robotics.

A. Parisi

Laparoscopic pancreaticoduodenectomy has not been particularly successful due to its technical complexity. Currently, there has been an increase in the development and diffusion of robotic systems applied to abdominal surgery. The objective of this video is to highlight how robotic surgery could revolutionize minimally invasive approach and is likely be useful even in complex surgical procedures. This report provides a description of the surgical technique used in our center for the execution of a robotic pancreaticoduodenectomy through the use of the ?Da Vinci Si? robotic system. In the reported clinical case operative time was 550 minutes, estimated blood loss was 250ml, there were no complications and hospitalization was 9 days. Robotic technology has made significant advantages over traditional laparoscopic approach, thus representing an evolution of minimally invasive techniques and opening up the possibility of safely perform procedures considered, to date, to be scarcely feasible and reproducible.

A new post has been published on Clinical Robotics.

D. Iddings
Dr. Iddings performing a total robotic whipple with PJ in patient with COPD and history of open AAA repair in past

A new post has been published on Clinical Robotics.

Pier C. Giulianotti (Chicago – USA) Shawn MacKenzie (Virginia – USA)

SUMMARY
The video shows the comparison of two different techniques for the pancreaticoduodenectomy (Whipple operation). PC Giulianotti and S MacKenzie compare the technique step by step: Port setting, Kocher Maneuver, hepatic hilum, ligament of treitz, mobilization of the duodeno jejunal flexure, pancreas neck, uncinate process, reconstruction. An interesting overview of the technical details of this complex advanced robotic procedure.

A new post has been published on Clinical Robotics.

P. Addeo

SUMMARY
This presentation describes a single surgeon ( Prof; PC Giulianotti) experience on robotic pancreaticoduodenectomy over a period of 9 years at two different centers. The intraoperative outcomes of 70 consecutive robotic Whipple’s operation are analyzed and the main technical points of this complex minimally invasive operation underlined.

Background/Hypothesis
Minimally invasive pancreaticoduodenectomy (PD) is a technically demanding procedure performed only in few centers worldwide. Laparoscopy has not gained popularity for this operation due to the technical intrinsic limitations of this approach. Robotic assistance may overcome these difficulties expanding the advantages of minimally invasive surgery for pancreatic surgery.

Materials & Methods
From May 2001 to July 2009 70 robotic PD has been performed. Data of patients undergoing robotic PD at the two different centres by a single surgeon were retrospectively reviewed.

Technique
All the procedures were performed with the da Vinci system. After a preliminary phases consisting of hybrid procedures (laparoscopy-robotic/15 cases), the procedures were performed by a full robotic technique. Six trocars were generally used. Exploratory laparoscopy and ultrasound exploration were performed in all the patients to rule out irresectability. The dissection of the portal vein at retropancreatic tunnel, the exposure and dissection of the uncinate process and the pancreatico-enteric reconstruction resulted particularly facilitated by robotic assistance. The distal pancreatic stump was managed as for open surgery (sclerosis/anastomosis) according to consistency of the pancreatic tissue and the characteristics of the duct.

Results
There were a total of 70 patients (36 women and 34 men) with a mean age of 64 years (range, 28-86). Conversion rate was 15.7 % (11/70). Overall postoperative morbidity was 28.5 % and mortality was 4.2 %. Pancreatic fistula occurred in 20% of patients who underwent a pancreatico-enterico reconstruction. The mean operative time was 420 min (range 240-660 min) and the mean blood loss was 310 ml (range 50-1500). The mean number of retrieved lymph node for malignant lesions was 18 (range 2-45).

Conclusions
Robotic pancreaticoduodenectomy is feasible, safe and with complication and mortality rates comparable to open surgery, while at the same time maintaining the advantages of minimally invasive surgery. A longer follow-up is needed to evaluate the survival rates for this technique.

A new post has been published on Clinical Robotics.