Name: Application of End-to-end Anastomosis in Robotic Central Pancreatectomy (Video) | JoVE Journal
Uploaded: 2018-06-02T13:30:00.000+00:00
Duration: 10 min 58 s
Description: Learn robotic central pancreatectomy with end-to-end anastomosis for pancreatic tumor surgery. This technique simplifies reconstruction, avoids pancreaticoenterostomy, and preserves gastrointestinal continuity.

ai_agent_IP

ai_agent

maintenance

instantTrialDurationMinutes

isBiopharma

enableNewMyJoveSectionDesign

educationFeatures

seoMetaApi

ai_copilot_institution_blacklist

ai_chat_institution_blacklist

freeAccessWindow

ssoRoleCapture

scheduledMaintenanceBanner

joveLabsFeatures

disable_autoplay_for_bots

extended_trial_duration

5 minutes

The authors have no acknowledgments.

Written informed consent was obtained from the patient for the publication of this report and any accompanying videos and images.
1. Preoperative Preparation
<ol>
	<li>Carefully evaluate the preoperative images of CT or MRI for the exact location of the tumor and its relation to the surrounding tissues.</li>
	<li>Give the patient a soft diet one day before the operation and begin fasting at midnight before the operation.</li>
	<li>Place the patient on the operating table. Then, place a peripheral venous catheter and induce general anesthesia using standard procedures. Introduce a central venous catheter through the right internal jugular vein for medication fluids and a peripheral arterial catheter for blood pressure monitor.</li>
</ol>
2. Patient&#39;s Position and Port Placement
<ol>
	<li>Place the patient in supine and 20&#176; reverse Trendelenburg position with the legs split. Drape in normal sterile fashion for upper abdominal surgery.</li>
	<li>Position the surgeon console at the left side of patient. Place the patient cart over the patient&#39;s head and the vision cart at the right side of the patient, respectively. Have the assistant surgeon stand between the patient&#39;s legs to perform the procedures. Position the back table for the instruments and supplies (see Table of Materials) at the left rear of the assistant.</li>
	<li>Make a 1-cm incision with the scalpel 3 cm inferior and right lateral to the umbilicus. Insert a Veress needle into the abdominal cavity through this incision, and establish a CO2 pneumoperitoneum of 14 mmHg with the automatic insufflation instrument.</li>
	<li>Remove the Veress needle and then insert a 12-mm trocar through the 1-cm incision as the camera port. Insert the robotic endoscope and perform a diagnostic laparoscopy (have the assistant surgeon hold the robotic endoscope) to confirm the abdominal adhesion status and operative feasibility. Insert the remaining 4 trocars as follows under the view of the endoscope.</li>
	<li>Place an 8-mm trocar in the left anterior axillary line (Figure 2) at the level of the umbilicus for the first robotic arm. Place a 12-mm trocar 2 cm inferior and left lateral to the umbilicus (Figure 2) as the assistant port.</li>
	<li>Place a 12-mm trocar in the right midclavicular line (Figure 2) at the level of the umbilicus. Insert an 8-mm trocar into this 12-mm trocar in a &#34;trocar in trocar&#34; fashion for the second robotic arm. Place an 8-mm trocar under the costal margin in the right middle axillary line for the third robotic arm (Figure 2). After the docking of robotic army, dock the robotic endoscope in the camera arm.</li>
</ol>
3. Mobilization of the Pancreas Neck and Body
<ol>
	<li>Grasp and keep elevating the anterior wall of the stomach by forceps on the third robotic arm to expose the gastrocolic ligament.</li>
	<li>Tension the gastrocolic ligament with the bipolar forceps in the second robotic arm and the grasping forceps in the assistant&#39;s hand. Divide the gastrocolic ligament to enter the lesser sac and expose the anterior surface of the pancreas with the laparoscopic ultrasonic scalpel on the first robotic arm. Perform hemostasis with bipolar forceps on the second robotic arm, until reaching the level of the right gastroepiploic vein.</li>
	<li>Carefully dissect the pancreatic neck from the superior and inferior direction with the cautery hook. Proceeding from the inferior to superior direction, divide the posterior wall of the pancreatic neck from the portal vein (PV), superior mesenteric vein (SMV), inferior mesenteric vein (IMV), and splenic vein (SV) with the cautery hook. Afterwards, create a tunnel between the PV-SMV-IMV-SV and posterior wall of the pancreatic neck.</li>
	<li>Dissect the pancreatic body from the splenic vessels and connective tissues towards the pancreatic tail with the cautery hook and ultrasonic scalpel.</li>
</ol>
4. Transection of the Pancreatic Parenchyma
<ol>
	<li>Insert the laparoscopic ultrasound probe through the assistant trocar and perform the ultrasonography on the pancreas to reconfirm the location and size of the lesion. According to the result of the ultrasonography, mark two transection lines at about 1 cm away from the lesion, on the pancreatic surface with the cautery hook.</li>
	<li>Lift the pancreatic body with the forceps inserting through the inferior margin of the pancreas and further detach the proximal part of pancreatic body from the splenic vessels and connective tissues with the cautery hook or ultrasonic scalpel.</li>
	<li>After mobilizing the pancreatic neck and proximal pancreatic body form the posterior vessels and tissues, incise the pancreas parenchyma along the distal and proximal transection line with the ultrasonic scalpel and expose the pancreatic duct. Then transect the parenchyma around the pancreatic duct.</li>
	<li>Carefully protect and mobilize the pancreatic duct from the transected pancreatic parenchyma. Then sharply transect the pancreatic duct about 1 cm away from the stump, using laparoscopic scissors from the assistant port.</li>
</ol>
5. Reconstruction of the Pancreatic Continuity
<ol>
	<li>To reduce the tension of anastomosis, further mobilize the pancreatic stump from the posterior vessels and connective tissues, using the cautery hook and bipolar forceps.</li>
	<li>Based on the size of the pancreatic duct stumps, choose a 10-cm plastic pancreatic stent with a proper diameter (1.2 mm in diameter in this case). Cut both ends of the stent to oblique planes and make several side perforations. Implant the stent into the abdominal cavity through the assistant port.</li>
	<li>Hold the side wall of pancreatic duct stump in the pancreatic body with micro forceps, and insert the stent caught by the needle driver into the distal pancreatic duct stump gently. Suture the pancreatic duct with the stent by using 5-0 absorbable suture, so that the stent is closely encircled by the pancreatic duct.</li>
	<li>Insert the other end of the stent into the proximal pancreatic duct stump using a similar approach but without suture.</li>
	<li>Suture the proximal and distal pancreatic stumps using the horizontal mattress suture (4-0 non-absorbable suture).</li>
	<li>Pull the two pancreatic stumps closer, and continue to insert the proximal end of stent into the proximal pancreatic duct stump. Finally, keep the whole stent within the pancreatic duct and do not bring it into the duodenum lumen.</li>
	<li>Perform the end-to-end anastomosis of the pancreatic duct stumps using interrupted suture with 5-0 non-absorbable suture.</li>
	<li>Knot the remaining ties on the pancreatic stumps.</li>
	<li>Suture the anterior portion of the pancreatic stumps using continuous suture with 4-0 non-absorbable suture (Figure 3).</li>
</ol>
6. Hemostasis and Drainage
<ol>
	<li>Carefully check for bleeding sites and conduct thorough hemostasis. Encircle the anastomosis site with absorbable hemostatic gauze.</li>
	<li>Put the resected specimen in the plastic bag and remove the bag from an enlarged incision in the camera port.</li>
	<li>Place two drains along the superior and inferior border of the anastomosis site and extract the drains from the port for the third robotic arm.</li>
</ol>
7. Posteoperative Care
<ol>
	<li>After surgery, give the patient intravenous antibiotics (ceftriaxone sodium), parenteral nutrition (glucose, compound vitamin, compound amino acid, fat emulsion, insulin, KCl, and NaCl), analgesic (sufentanil, ondansetron), somatostatin, proton pump inhibitors (lansoprazole) and other treatment as the same as that of conventional central pancreaticectomy. Keep the patient fasting, then remove the nasogastric tube and feed a clear fluid diet on the 2nd postoperative day. Gradually transition to normal diet if the patient can tolerate it.</li>
	<li>Test the drain fluid for the amylase and bacterial culture after the 3rd postoperative day. When there is no evidence of pancreatic fistula and infection, and the drain volume is less than 10 mL/day, remove the drains.</li>
</ol>

<ol><li>Goudard, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Reappraisal+of+central+pancreatectomy+a+12-year+single-center+experience%5BTitle%5D)+AND+%22JAMA+Surg%22%5BJournal%5D)">Reappraisal of central pancreatectomy a 12-year single-center experience.</a> JAMA Surg. 149 (4), 356-363 (2014).</li>
<li>Iacono, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Systematic+review+of+central+pancreatectomy+and+meta-analysis+of+central+versus+distal+pancreatectomy%5BTitle%5D)+AND+%22Br+J+Surg%22%5BJournal%5D)">Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy.</a> Br J Surg. 100 (7), 873-885 (2013).</li>
<li>Sperti, C., Beltrame, V., Milanetto, A. C., Moro, M., Pedrazzoli, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Parenchyma-sparing+pancreatectomies+for+benign+or+border-line+tumors+of+the+pancreas%5BTitle%5D)+AND+%22World+Journal+of+Gastrointestinal+Oncology%22%5BJournal%5D)">Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas.</a> World Journal of Gastrointestinal Oncology. 2 (6), 272-281 (2010).</li>
<li>Kim, D. H., Kang, C. M., Lee, W. J., Chi, H. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+central+pancreatectomy+with+pancreaticogastrostomy+%28transgastric+approach%29+in+a+solid+pseudopapillary+tumor+of+the+pancreas%5BTitle%5D)+AND+%22Hepato-gastroenterology%22%5BJournal%5D)">Robotic central pancreatectomy with pancreaticogastrostomy (transgastric approach) in a solid pseudopapillary tumor of the pancreas.</a> Hepato-gastroenterology. 58 (110-111), 1805-1808 (2011).</li>
<li>Addeo, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+central+pancreatectomy+with+stented+pancreaticogastrostomy%3A+operative+details%5BTitle%5D)+AND+%22The+international+journal+of+medical+robotics+%2B+computer+assisted+surgery%3A+MRCAS%22%5BJournal%5D)">Robotic central pancreatectomy with stented pancreaticogastrostomy: operative details.</a> The international journal of medical robotics + computer assisted surgery: MRCAS. 7 (3), 293-297 (2011).</li>
<li>Abood, G. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic-assisted+minimally+invasive+central+pancreatectomy%3A+technique+and+outcomes%5BTitle%5D)+AND+%22J+Gastrointest+Surg%22%5BJournal%5D)">Robotic-assisted minimally invasive central pancreatectomy: technique and outcomes.</a> J Gastrointest Surg. 17 (5), 1002-1008 (2013).</li>
<li>Schwarz, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Total+Laparoscopic+Central+Pancreatectomy+with+Pancreaticogastrostomy+for+High-Risk+Cystic+Neoplasm%5BTitle%5D)+AND+%22Annals+of+surgical+oncology%22%5BJournal%5D)">Total Laparoscopic Central Pancreatectomy with Pancreaticogastrostomy for High-Risk Cystic Neoplasm.</a> Annals of surgical oncology. 23 (3), 1035(2016).</li>
<li>Topal, B., et al. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pubmed/23643139">Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial.</a> The Lancet Oncology. 14 (7), 655-662 (2013).</li>
<li>Lemaire, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Functional+and+morphological+changes+in+the+pancreatic+remnant+following+pancreaticoduodenectomy+with+pancreaticogastric+anastomosis%5BTitle%5D)+AND+%22Br+J+Surg%22%5BJournal%5D)">Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis.</a> Br J Surg. 87 (4), 434-438 (2000).</li>
<li>Rault, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Pancreaticojejunal+Anastomosis+Is+Preferable+to+Pancreaticogastrostomy+after+Pancreaticoduodenectomy+for+Longterm+Outcomes+of+Pancreatic+Exocrine+Function%5BTitle%5D)+AND+%22Journal+of+the+American+College+of+Surgeons%22%5BJournal%5D)">Pancreaticojejunal Anastomosis Is Preferable to Pancreaticogastrostomy after Pancreaticoduodenectomy for Longterm Outcomes of Pancreatic Exocrine Function.</a> Journal of the American College of Surgeons. 201 (2), 239-244 (2005).</li>
<li>Lai, E. C., Tang, C. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+distal+pancreatectomy+versus+conventional+laparoscopic+distal+pancreatectomy%3A+a+comparative+study+for+short-term+outcomes%5BTitle%5D)+AND+%22Frontiers+of+medicine%22%5BJournal%5D)">Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.</a> Frontiers of medicine. 9 (3), 356-360 (2015).</li>
<li>Konstantinidis, I. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+total+pancreatectomy+with+splenectomy%3A+technique+and+outcomes%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Robotic total pancreatectomy with splenectomy: technique and outcomes.</a> Surg Endosc. , (2017).</li>
<li>Liu, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+surgical+outcomes+of+robot-assisted+laparoscopic+pancreaticoduodenectomy+versus+laparoscopic+pancreaticoduodenectomy+for+periampullary+neoplasms%3A+a+comparative+study+of+a+single+center%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center.</a> Surg Endosc. 31 (6), 2380-2386 (2017).</li>
<li>Lui, R., Zhao, G., Yin, Z., Zhao, J. Robotic enucleation for pancreatic neoplasm with interposition repair of the main pancreatic duct: a case report. Chinese Journal of Laparoscopic Surgery. 9 (6), Electronic Edition 373-374 (2016).</li>
<li>Ehrhardt, O. Ueber Resektionen am Pankreas1. DMW-Deutsche Medizinische Wochenschrift. 34, 595-597 (1908).</li>
<li>Wolk, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+central+pancreatectomy+and+pancreatic+enucleation+as+pancreatic+resections--A+comparison%5BTitle%5D)+AND+%22Int+J+Surg%22%5BJournal%5D)">Evaluation of central pancreatectomy and pancreatic enucleation as pancreatic resections--A comparison.</a> Int J Surg. 22, 118-124 (2015).</li>
<li>Ishii, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Remnant+pancreas+reconstruction+with+duct-to-duct+anastomosis+after+middle+pancreatectomy%3A+a+report+of+two+cases%5BTitle%5D)+AND+%22Hepato-gastroenterology%22%5BJournal%5D)">Remnant pancreas reconstruction with duct-to-duct anastomosis after middle pancreatectomy: a report of two cases.</a> Hepato-gastroenterology. 62 (137), 190-194 (2015).</li>
<li>Di Benedetto, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Meso-pancreatectomy%3A+new+surgical+technique+for+Wirsung+reconstruction%5BTitle%5D)+AND+%22J+Am+Coll+Surg%22%5BJournal%5D)">Meso-pancreatectomy: new surgical technique for Wirsung reconstruction.</a> J Am Coll Surg. 214 (2), 1-4 (2012).</li>
<li>Oida, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((End-to-end+anastomosis+after+medial+pancreatectomy+for+tumor%5BTitle%5D)+AND+%22Hepato-gastroenterology%22%5BJournal%5D)">End-to-end anastomosis after medial pancreatectomy for tumor.</a> Hepato-gastroenterology. 54 (76), 1266-1268 (2007).</li>
<li>Ramesh, H. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pubmed/12075189">End-to-end anastomosis of pancreas.</a> Surgery. 131 (6), 691-693 (2002).</li>
<li>Kang, C. M., Kim, D. H., Lee, W. J., Chi, H. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Initial+experiences+using+robot-assisted+central+pancreatectomy+with+pancreaticogastrostomy%3A+a+potential+way+to+advanced+laparoscopic+pancreatectomy%5BTitle%5D)+AND+%22Surgical+endoscopy%22%5BJournal%5D)">Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy.</a> Surgical endoscopy. 25 (4), 1101-1106 (2011).</li>
<li>Lee, J. W., Yoo, J., Ko, J. W., Choi, S. H. <a target="_blank" href="https://www.e-sciencecentral.org/articles/SC000025524">Robotic Central Pancreatectomy with Pancreaticojejunostomy for Solid Pseudopapillary Neoplasm.</a> Journal of Minimally Invasive Surgery. 20 (2), 74-76 (2017).</li>
<li>Ronnekleiv-Kelly, S. M., Javed, A. A., Weiss, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Minimally+invasive+central+pancreatectomy+and+pancreatogastrostomy+current+surgical+technique+and+outcomes%5BTitle%5D)+AND+%22The+Journal+of+Visualized+Surgery%22%5BJournal%5D)">Minimally invasive central pancreatectomy and pancreatogastrostomy current surgical technique and outcomes.</a> The Journal of Visualized Surgery. 2 (8), (2016).</li>
<li>Liu, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+versus+laparoscopic+distal+pancreatectomy%3A+A+propensity+score-matched+study%5BTitle%5D)+AND+%22Journal+of+surgical+oncology%22%5BJournal%5D)">Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study.</a> Journal of surgical oncology. 116 (4), 461-469 (2017).</li>
</ol>

No competing financial interests exist.

Malignant tumors located in the pancreas neck and the proximal part of the pancreatic body are often treated with pancreaticoduodenectomy or distal pancreatectomy. However, for benign or low malignant potential tumors in those sites, the standard pancreaticoduodenectomy or distal pancreatectomy will remove excessive normal tissues and result in excessive injury. Therefore, the central pancreatectomy or pancreatic enucleation, known as &#34;parenchyma-sparing pancreatectomy&#34;, becomes a preferable choice for the treatm...

Central pancreatectomy is increasingly performed for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of pancreatic body1. Compared with the pancreaticoduodenectomy or distal pancreatectomy, central pancreatectomy resects less tissues and conserves more pancreatic parenchyma and function. Currently, the major approaches for the pancreas reconstruction are over-sewing the cephalic pancreatic stump and performing a pancreaticojejunostomy or pancreaticogastrostomy to the distal stump2,3. These two approaches are widely used in the open, laparoscopic and robotic central pancreatectomies4,5,6,7. However, the aforementioned two reconstruction approaches break the anatomic continuity of digestive tracts and the pathway for the excretion of pancreatic fluid. The directly contact of pancreatic stump with intestinal juice might increase the possibility of bleeding and fistula8. Although the gastric juice could inactive pancreatic enzymes to avoid the erosion of anastomosis, it might lead to pancreatic exocrine insufficiency, and in the long term jeopardize the patient&#39;s nutritional status9,10.
With the development of minimally invasive surgery, robotic surgery has shown great advantages in its 3-D magnifying view, stability, and flexibility of movements, etc., which provides enhanced dissecting and suturing capacity for anastomosis and hemostasis11,12. Based on our experience in robotic pancreatectomy and repair for injured pancreatic duct13,14, we have performed a series of robotic central pancreatectomy with end-to-end anastomosis and seen favorable outcomes. Compared with pancreaticojejunostomy or pancreaticogastrostomy, end-to-end pancreas anastomosis avoids the damage to digestive tracts; thus, theoretically reducing the possibility of pancreaticoenteric fistula. But on the other hand, the end-to-end pancreas anastomosis poses greater technical difficulties. As an update of conventional central pancreatectomy, the candidates for conventional central pancreatectomy are also eligible for this surgery. Here, we present operative techniques for robotic central pancreatectomy with end-to-end anastomosis in a tertiary hepatopancreatobiliary center in this video case presentation.
Indications:
(1) Benign and low-malignant potential tumors located in the pancreatic neck and proximal body are suitable for this operation. 
(2) The defect of the main pancreatic duct should be less than 5 cm after the central pancreatectomy, and the size of tumor is not the main concern for reconstruction.
Case Presentation:
The patient is a 31-year-old man. A lesion in the pancreatic neck was found accidently in a medical examination 2 years ago. He underwent regular re-examination and the lesion was found to be asymptomatically enlarged recently. He had no history of previous abdominal surgery. On physical examination, no positive sign existed. The pancreatic MRI showed a quasi-circular lesion approximately 14-mm in the pancreatic neck; this was presumed as a neuroendocrine tumor. On T1- and T2-weighted imaging, the lesion showed hypointense and hyperintense signal, respectively. On diffusion-weighted imaging, the lesion showed hyperintense signal. The lesion was slightly enhanced in the arterial phase and showed a progressive enhancement pattern in the parenchyma phase and delay phase (Figure 1). Severe fatty liver was also diagnosed by the MRI. No dilation or stricture was detected in the pancreatic duct. Routine blood examination, IgG isoform test, tumor biomarkers, electrocardiogram, and chest X-ray were normal. The biochemical test showed slightly elevated ALT (Alanine aminotransferase) at 147.3 U/L and AST (Aspartate aminotransferase) at 53.9U/L, which may be caused by fatty liver.

<table><tbody><tr><td>da Vinci Robotic Surgical System</td><td>Intuitive&amp;nbsp;Surgical, USA</td><td>Si</td><td></td></tr><tr><td>EndoWrist Permanent Cautery Hook</td><td>Intuitive&amp;nbsp;Surgical, USA</td><td>420183</td><td></td></tr><tr><td>Harmonic Ace Curved Shears</td><td>Ethicon, USA</td><td>420275</td><td></td></tr><tr><td>EndoWrist Large needle Driver</td><td>Intuitive&amp;nbsp;Surgical, USA</td><td>420006</td><td></td></tr><tr><td>EndoWrist Cadiere Forceps</td><td>Intuitive&amp;nbsp;Surgical, USA</td><td>420049</td><td></td></tr><tr><td>EndoWrist Black Diamond Micro Forceps</td><td>Intuitive&amp;nbsp;Surgical, USA</td><td>420033</td><td></td></tr><tr><td>Lapro-Clip 8 mm Absorbable Clips</td><td>Covidien&amp;nbsp; , USA</td><td>8886848882</td><td></td></tr><tr><td>5-0 non-absorbable suture</td><td>Ethicon, USA</td><td>M8717</td><td></td></tr><tr><td>4-0 non-absorbable suture</td><td>Ethicon, USA</td><td>D9775</td><td></td></tr><tr><td>5-0 absorbable suture</td><td>Ethicon, USA</td><td>D9943</td><td></td></tr><tr><td>Absorbable hemostas</td><td>Ethicon, USA</td><td>W1912</td><td></td></tr><tr><td>Laparoscopic Ultrasound Probe</td><td>BK Ultrasound, Denmark</td><td>8666-RF</td><td>transducer contact surface: 30*5mm; Frequence: 4.3-10 MHz</td></tr><tr><td>Pancreatic stent</td><td>Yaxin Medical, Suzhou, China</td><td>1.2 mm&amp;nbsp;</td><td></td></tr><tr><td>Antibiotics&amp;nbsp;(ceftriaxone sodium for injection)</td><td>Roche, Shanghai, China</td><td>H10983036</td><td>ceftriaxone sodium (2g) adding to normal saline (100ml), once per day.</td></tr><tr><td>Proton pump inhibitors (lansoprazole injection)&amp;nbsp;</td><td>Luoxin Pharmaceutical, Linyi, China</td><td>H20055118</td><td>lansoprazole injection (30 mg) adding to normal saline (100ml), twice per day.</td></tr><tr><td>Somatostatin (Somatostatin for injection)</td><td>Merck Serono, Germany</td><td>H20090929</td><td>Somatostatin for injection (6000ug) adding to nornal saline to a total of 48ml, 2 ml/h</td></tr><tr><td>&lt;strong&gt;Analgesic&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Analgesic (sufentanil Citrate injection)</td><td>Humanwell Healthcare, Fuzhou, China</td><td>H20054171</td><td>sufentanil Citrate (200ug),&amp;nbsp; Ondansetron hyrochloride (20mg), adding to normal saline to a total of 80 ml, 1 ml/h</td></tr><tr><td>Analgesic (Ondansetron hyrochloride injection)</td><td>Qilu Pharmaceutical, Hainan, China</td><td>H10970065</td><td>sufentanil Citrate (200ug),&amp;nbsp; Ondansetron hyrochloride (20mg), adding to normal saline to a total of 80 ml, 2 ml/h</td></tr><tr><td>&lt;strong&gt;Parenteral nutrition&amp;nbsp;&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Parenteral nutrition(Compond vitamin injection)</td><td>Pude Pharmaceutical, Datong, China</td><td>H20093720</td><td>1 piece</td></tr><tr><td>Parenteral nutrition(Compond amino acid injection)</td><td>Kelun Pharmaceutical, Chengdu, China</td><td>H20066058</td><td>500 ml</td></tr><tr><td>Parenteral nutritionz(Fat emulsion injection)</td><td>Fresenius Kabi AB, Sweden</td><td>H20160019</td><td>250 ml</td></tr><tr><td>Parenteral nutrition(10%KCl injection)</td><td>Jinyao Pharmaceutical, Tianjin, China</td><td>H12020518</td><td>50 ml</td></tr><tr><td>Parenteral nutrition(10%NaCl injection)</td><td>CR, Double-Crane, Beijing, China</td><td>H11020865</td><td>50 ml</td></tr><tr><td>Parenteral nutrition(Insulin injection)</td><td>No.1 biochemical and pharmaceutical, Shanghai, China</td><td>H31020519</td><td>28 Unit</td></tr></tbody></table>

application of end-to-end anastomosis in robotic central pancreatectomy

Application of End-to-end Anastomosis in Robotic Central Pancreatectomy

Central pancreatectomy is carried out for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of pancreatic body. With technological development, the robotic surgical system has shown its advantage in minimally invasive surgery and been increasingly applied in central pancreatectomy. However, reconstruction of the continuity of pancreas with end-to-end anastomosis after robotic central pancreatectomy has not been applied. In this study, we report surgical techniques for robotic central pancreatectomy with end-to-end anastomosis. The pancreas is reconstructed by duct-to-duct anastomosis of the pancreatic duct with a pancreatic stent inserted in the two stumps of pancreatic duct, and by end-to-end anastomosis of the pancreatic parenchyma. Compared with traditional central pancreatectomy with pancreaticoenteric anastomosis, this approach decreases the operative injury to the patient, and also conserves the integrity and continuity of the digestive duct and pancreatic duct. The robotic surgical system integrated with multiple instruments with flexible and precise movement is particularly suitable for the dissection and reconstruction of the pancreatic duct. We found that robotic central pancreatectomy with end-to-end anastomosis is safe and feasible, and we need more experience to evaluate its best indications and long-term outcomes.

The operation process was smooth. The operative time was 141 mins and the intraoperative blood loss was about 50 mL. The size of the resected pancreas was about 5.5 × 2.5 × 2.5 cm (Figure 4). The patient recovered smoothly after surgery and discharged on the 6th postoperative day. When the patient was discharged, he had a normal diet and normal defecation, and had no fever, no abdominal pain or distension. The routine blood examination and blood bi...

The robotic central pancreatectomy with end-to-end anastomosis is feasible and safe for tumor in the pancreatic neck and proximal portion of pancreatic body. The operative techniques of this operation are presented.

Central pancreatectomy is carried out for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of ...

application-end-to-end-anastomosis-robotic-central

Research

JoVE Journal

Medicine

The following manuscript details a stepwise approach to the robot-assisted pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.

Technical Detail for Robot Assisted Pancreaticoduodenectomy

Robotic lateral pancreaticojejunostomy (RLPJ) may be used in patients with painful, morphine dependent, chronic pancreatitis and a dilated main pancreatic duct. We describe a standardized and reproducible technique for RLPJ, which includes transection of the gastroduodenal artery.

Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis

The robotic technique shown herein aims at faithfully reproducing the open procedure for radical treatment of cancer of the body-tail of the pancreas. The protocol also demonstrates the ability to master involvement of major peripancreatic vessels without conversion to open surgery.

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

We present our operative approach to robot assisted distal pancreatectomy, splenectomy, and celiac axis resection (DP-CAR), demonstrating that the procedure is safe and feasible with proper planning, patient selection, and surgeon experience.

Robot Assisted Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer: Surgical Planning and Technique

Robotic central pancreatectomy may be used in selected patients in experienced centers. This protocol presents all steps and the feasibility of a robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy in a 16-year-old adolescent patient.

Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy

Robotic pancreatoduodenctomy (RPD) has been highly standardized in recent years and may be used in selected patients with pancreatic head cancer, including those with a replaced right hepatic artery. This case report describes a standardized and reproducible technique for RPD, which includes the approach of the Dutch LAELAPS-3 training program to an aberrant vasculature.

Robotic Pancreatoduodenectomy for Pancreatic Head Cancer: a Case Report of a Standardized Technique

This protocol presents a case of a robotic partial duodenal resection with primary side-to-side duodeno-jejunal reconstruction in a patient with a 5 cm duodenal stenosis. This is done at the third duodenal segment (D3) after an endoscopic mucosal resection (EMR) for a duodenal polyp.

Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis

The present protocol describes the application of mid-pancreatectomy combined with end-to-end anastomosis in the surgical treatment of pancreatic benign tumors, which presents a feasible solution for managing such tumors while concurrently preserving pancreatic function.

Application of Mid-Pancreatectomy with End-to-End Anastomosis in Pancreatic Benign Tumors

This protocol presents a method for performing a parenchymal sparing robotic-assisted lateral pancreaticojejunostomy intended for appropriately selected patients with a pancreatic duct obstruction without significant inflammation of the pancreatic head. This article demonstrates critical aspects of the operation in a minimally invasive, robotic fashion to treat recurrent acute/chronic pancreatitis.

Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis

This protocol presents robotic duodenum-preserving total pancreatic head resection (R-DPPHRt) for intraductal papillary mucinous neoplasms (IPMNs). A video demonstrates the technique in a patient with main duct-IPMN, highlighting its feasibility as a minimally invasive, organ-preserving alternative to pancreaticoduodenectomy.

Robotic Duodenum-preserving Total Pancreatic Head Resection for Intraductal Papillary Mucinous Neoplasms

This article presents laparoscopic central pancreatectomy with pancreatic duct end-to-end anastomosis as an important surgical approach for middle-segment pancreatic benign and low-grade malignant tumors.

Treatment of Middle-segment Pancreatic Benign Tumor Using Laparoscopic Central Pancreatectomy with End-to-end Pancreatic Duct Reconstruction

Learn robotic central pancreatectomy with end-to-end anastomosis for pancreatic tumor surgery. This technique simplifies reconstruction, avoids pancreaticoenterostomy, and preserves gastrointestinal continuity.

Application of End-to-end Anastomosis in Robotic Central Pancreatectomy

Explore More Videos