Name: Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis (Video) | JoVE Journal
Uploaded: 2025-09-05T14:40:00.000+00:00
Duration: 11 min 7 s
Description: Learn robotic-assisted lateral pancreaticojejunostomy for chronic pancreatitis using minimally invasive techniques. This procedure preserves pancreatic tissue while relieving duct obstruction and improving patient outcomes.

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5 minutes

The authors have no acknowledgments.

Per West Virginia University Office of Human Research Protections protocols and consistent with federal policy, this protocol is classified as non-human subjects research and does not require Institutional Review Board approval. As part of our standard surgical consent process, patients provided informed consent for intraoperative video recording.
1. Patient positioning and port placement
<ol>
	<li>The patient was placed supine on a split-leg table with their arms out. Sterile preparation was applied using a chlorhexidine applicator, and the patient was draped in a standard fashion. An incision was made in the upper left quadrant to allow for abdominal entry with the optical separator device. The peritoneal cavity was insufflated with CO2 and explored with the laparoscope.</li>
	<li>Four robotic ports were inserted in the upper abdomen, and two assistant ports were inserted in the lower abdomen (Figure 3). The camera was placed in the midline supraumbilical robotic port. In the left lower quadrant, a 12 mm port served as the site for stapler insertion.</li>
	<li>After ports were inserted, the patient was placed in reverse Trendelenburg with their left side up.</li>
</ol>
2. Entry into the lesser sac and docking the robot
<ol>
	<li>A flexible triangle liver retractor was introduced in the right upper quadrant just caudal to the ribs to retract the liver cranially. The lesser sac was entered using bipolar electrocautery along the greater curvature of the stomach, taking care not to cauterize the gastroepiploic vessels. Following mobilization of the stomach, it was retracted anteriorly along with the liver.</li>
	<li>The robot was docked, ensuring that the surgeon controlled the robot sitting at the console and a bedside laparoscopic assistant standing between the patient&#39;s legs.</li>
</ol>
3. Identifying the pancreatic duct and longitudinal incision along the body of the pancreas
<ol>
	<li>Intraoperative ultrasound was used to identify the dilated pancreatic duct, locate strictures, and track the course of the duct along the body of the pancreas.</li>
	<li>The body of the pancreas was incised using cauterized scissors primarily along the anterior surface of the duct to the tail. A 4-French Hobbs stent can be used to track the pancreatic duct as it is opened (Figure 4).</li>
</ol>
4. Dividing loop of jejunum and passage through the retrocolic tunnel
<ol>
	<li>Once the pancreatic duct was opened, the ligaments of Treitz and the proximal jejunum were identified. 20 cm distal to this, a loop of jejunum was identified as the site for future anastomosis with the pancreatic duct.</li>
	<li>Using a bipolar electrocautery device, a mesenteric window was created, and the bowel was divided with a 60 mm purple load of an Endo GIA stapler. The bipolar electrocautery device was again used to divide the mesentery with care to avoid mesenteric vasculature.</li>
	<li>A retrocolic tunnel was created in the mesentery of the transverse colon using blunt dissection. The Roux limb was then subsequently passed through this space into the lesser sac. It was ensured that the jejunum reached the pancreas without tension.</li>
</ol>
5. Longitudinal enterotomy and running anastomosis
<ol>
	<li>A longitudinal enterotomy on the anti-mesenteric aspect of the jejunum was created using a combination of electrocautery and sharp dissection to match the length of the incision along the pancreas.</li>
	<li>The anastomosis began at the tail of the pancreas, where two 3-0 barbed sutures were anchored to the distal end of the ductotomy and enterotomy. One barbed suture was run along the inferior aspect of the anastomosis, while the other was run along the superior aspect of the anastomosis. Again, a 4-French Hobbs stent was used to ensure the duct remains patent, particularly at the beginning and end of anastomosis creation (Figure 4).</li>
	<li>The anastomosis was completed when the barbed sutures met at the neck of the pancreas, where they were tied together.</li>
</ol>
6. Re-establishing GI continuity with jejunojejunostomy
<ol>
	<li>Neo-gastrointestinal anatomy was confirmed by identification of the Roux and Biliopancreatic limbs. Small enterotomies were created near the previously stapled edge of the jejunum and a segment of jejunum more distal at the Roux limb, approximately 50 cm. A 60 mm purple load endo GIA staple fire was used to create a side-to-side jejunojejunostomy.</li>
	<li>The common enterotomy was closed with 3-0 barbed sutures followed by interrupted 3-0 silk Lembert sutures. 3-0 silk sutures were again used to close the colon mesenteric defect created around the Roux limb.</li>
</ol>
7. Placing drains and abdominal closure
<ol>
	<li>Two drains were placed using previously placed robotic port-sites. One drain passed posterior to the pancreaticojejunal anastomosis, and the other anterior to the anastomosis. The liver retractor was removed, and the stomach was returned to anatomical position.</li>
	<li>The abdomen was extensively irrigated. A laparoscopic port-site closure device was used to close a 12 mm assistant port with #1 absorbable sutures. The skin and subcutaneous tissue were irrigated and closed with 4-0 monofilament absorbable suture.</li>
</ol>

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<li>Niemann, B., Kenney, C., Marsh, J. W., Schmidt, C., Boone, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Implementing+a+robotic+hepatopancreatobiliary+program+for+new+faculty%3A+safety%2C+feasibility+and+lessons+learned%5BTitle%5D)+AND+%22J+Robot+Surg%22%5BJournal%5D)">Implementing a robotic hepatopancreatobiliary program for new faculty: safety, feasibility and lessons learned.</a> J Robot Surg. 18 (1), 253(2024).</li>
<li>Cahen, D. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Endoscopic+versus+surgical+drainage+of+the+pancreatic+duct+in+chronic+pancreatitis%5BTitle%5D)+AND+%22N+Engl+J+Med%22%5BJournal%5D)">Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.</a> N Engl J Med. 356 (7), 676-684 (2007).</li>
<li>Olesen, S. S., Büyükuslu, A., Køhler, M., Rasmussen, H. H., Drewes, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Sarcopenia+associates+with+increased+hospitalization+rates+and+reduced+survival+in+patients+with+chronic+pancreatitis%5BTitle%5D)+AND+%22Pancreatology%22%5BJournal%5D)">Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis.</a> Pancreatology. 19 (2), 245-251 (2019).</li>
<li>Ahmed Ali, U., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Endoscopic+or+surgical+intervention+for+painful+obstructive+chronic+pancreatitis%5BTitle%5D)+AND+%22Cochrane+Database+Syst+Rev%22%5BJournal%5D)">Endoscopic or surgical intervention for painful obstructive chronic pancreatitis.</a> Cochrane Database Syst Rev. 1, CD007884(2012).</li>
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The authors have nothing to disclose.

Here we present a robotic approach to lateral pancreaticojejunostomy for the management of chronic pancreatitis with pancreatic duct stricture. Critical steps demonstrated for a successful operation include our precise robotic port placement, the use of intra-operative ultrasound to track the pancreatic duct along the pancreatic body, and performing a longitudinal pancreatic ductotomy with the use of a 4-French Hobbs stent. Additionally, our technique for the pancreaticojejunostomy anastomosis is highlighted using two ru...

Lateral pancreaticoduodenectomy, more often referred to as a modified Puestow procedure, is a pillar of open pancreatic surgery. First performed in 1958, this procedure addresses complex chronic pancreatitis with a dilated pancreatic duct and normal pancreatic head while preserving much of the pancreatic parenchyma1. Primary indications for this operation include chronic pancreatitis with chronic pain, narcotic dependency, and poor quality of life. Drainage procedures typically involve relief of obstruction in the pancreatic duct while preserving the pancreatic head parenchyma. The Puestow procedure falls into the category of drainage procedures for chronic pancreatitis, a group that also includes the Partington and Rochelle modification and the Izbicki procedure2. The vast majority of patients with chronic pancreatitis present with the involvement of the pancreatic head and are thus not eligible for drainage procedures and instead undergo resection. The pancreaticoduodenectomy is an extensive procedure with resection of the pancreatic head, duodenum, and a portion of the stomach. The Beger and Frey procedures are also parenchymal resection procedures that involve the removal of the lesion from the pancreatic head while sparing the duodenum and more of the pancreatic parenchyma3.
For much of the history of treatment for chronic pancreatitis, drainage procedures and pancreaticoduodenectomy were the mainstay of treatment. The optimal surgical approach for chronic pancreatitis remains unanswered and should be individualized based on clinical, imaging, and endoscopic assessment. As detailed in the discussion, surgical drainage procedures have recently been shown to have significantly lower 90-day readmission rates and need for reintervention, with no differences in pain scores compared to resective procedures4. However, in the era of minimally invasive surgery, drainage procedures have fallen out of favor as compared with other current options: laparoscopic or robotic pancreaticoduodenectomy and duodenal-preserving pancreatic head resections5,6. While these procedures provide a safe and attainable treatment for the majority of chronic pancreatitis patients, they are highly morbid operations that resect already diseased parenchyma, further increasing the risk of endocrine and exocrine dysfunction. Pancreaticoduodenectomy is most often linked to delayed gastric emptying, bleeding, pancreatic insufficiency, and infection7. Distal pancreatectomy is most often complicated by pancreatic fistula and abscess formation/infection3,8,9. In the interest of preserving pancreatic parenchyma in the surgical treatment of chronic pancreatitis, robotic lateral pancreaticojejunostomy may have an underestimated utility.
Use of robotic surgery in the management of pancreatic disease has advanced rapidly in the past decade, similar to the implementation of laparoscopic surgery decades prior. Both robotic and laparoscopic approaches are associated with decreased recovery times and lower levels of post-operative pain, allowing patients to return to their day-to-day lives sooner10,11,12. The robotic platform has the additional benefits of 3-dimensional visualization with high magnification and articulating instruments, which is particularly advantageous with the manipulation of delicate pancreatic tissue and suturing complex anastomoses. The extent of a learning curve for robotic pancreatic surgery is controversial; however, it is generally agreed that mastery of port placement and coordination with laparoscopic assistance is critical13. As more surgeons graduate from training programs with this skill set, utilizing the versatility of the robotic platform to leverage a minimally invasive approach to all pancreatic procedures that are possible with open surgery is feasible and may improve outcomes associated with surgery for pancreatitis14.
This paper provides a clear and easily adaptable method for robotic-assisted lateral pancreatojejunostomy. As more surgical techniques are adapted to robotic surgery, we include the largely historical drainage approach in this growing list and ensure the technique is accessible to fellowship-trained hepatobiliary surgeons.
CASE PRESENTATION: 
We report a 39-year-old male with no significant past medical history and no history of alcohol or tobacco use. He presents with recurrent episodes of pancreatitis for 5 years in the setting of gallstone pancreatitis, for which a laparoscopic cholecystectomy was performed at the time of his initial presentation. Unfortunately, the episodes recurred and worsened over time. After presentation to our facility, he underwent endoscopic retrograde cholangiopancreatography (ERCP), which revealed pancreatic divisum and pancreatic duct stricture at the neck, which could not be traversed for duct stent placement.
Diagnosis, Assessment, and Plan: 
As previously stated, the patient had a significant pancreatic duct stricture in the neck of the pancreas, evidenced by the pancreatogram (Figure 1). Magnetic resonance cholangiopancreatography (MRCP) further elucidated irregular upstream dilation of the pancreatic duct in the body and tail of the pancreas (Figure 2). Importantly, these studies revealed no significant disease of the pancreatic head or major biliary involvement, indicating that this patient was a candidate for a robotic pancreatic drainage procedure to decompress the distal pancreatic duct, thereby limiting further episodes of pancreatitis.

<table><tbody><tr><td>Pneumoclear smoke evacuation tube set</td><td>STRYKER</td><td>620050350</td><td>Smoke evacuator tubing</td></tr><tr><td>Smoke MGMT EXTD Nozzle for 4in electrode</td><td>Medtronic</td><td>VSMEN4</td><td>Electrocautery pencil with smoke evacuation</td></tr><tr><td>Smoke pencil with edge electrode 10Ft</td><td>Medtronic</td><td>VSMP10</td><td>Electrode for electrocautery</td></tr><tr><td>BLAKE Silicone Drain, Size 19 Fr, Round</td><td>Ethicon</td><td>2232</td><td>Abdominal drain</td></tr><tr><td>Jackson-Pratt bulb reservoir 100cc</td><td>McKesson</td><td>SU1301305</td><td>Drainage suction bulb reservoir</td></tr><tr><td>Garment compress Medium, Calf</td><td>Zimmer Biomet</td><td>VG501M</td><td>Sequential compression device applied to calves for deep venous thrombosis prophylaxis</td></tr><tr><td>Suction tube handle, Bulb tip Yankauer</td><td>McKesson</td><td>K86</td><td>Yankauer Suction handle</td></tr><tr><td>Suction Tubing 20FT, 9/32 inch</td><td>McKesson</td><td>N720A</td><td>Suction tubing</td></tr><tr><td>BD ChloraPrep Hi-Lite Orange 26-mL applicator with sterile solution</td><td>BD (Becton, Dickinsone and Company)</td><td>930815</td><td>Sterile Chlorhexidine preparation</td></tr><tr><td>80mm Angled Triangle base, 5mm</td><td>Mediflex</td><td>91683-A</td><td>Flexible liver retractor</td></tr><tr><td>Optical Obturator, 8mm, bladeless</td><td>Intuitive Surgical</td><td>470359</td><td>Obturator for placement of robotic trocar</td></tr><tr><td>Monopolar Curved scissor tip cover accessory</td><td>Intuitive Surgical</td><td>400180</td><td></td></tr><tr><td>Da Vinci XI Universal Seal 5-12mm</td><td>Intuitive Surgical</td><td>470500</td><td>Robotic Trocar seal</td></tr><tr><td>Endo GIA Ultra Universal Stapler</td><td>Covidien</td><td>EGIAUXL</td><td>Laparoscopic stapler</td></tr><tr><td>Stapler reload, 60mm, reinforced</td><td>Covidien</td><td>SIGTRSB60AXT</td><td></td></tr><tr><td>Skin Stapler</td><td>Covidien</td><td>8886803712</td><td>Skin stapler</td></tr><tr><td>SURGICEL Absorbable Hemostat</td><td>Ethicon</td><td>1952S</td><td>Hemostatic cellulose</td></tr><tr><td>Laparoscopic Clip applier 5mm</td><td>Covidien</td><td>176630</td><td>Laparoscopic clip applier</td></tr><tr><td>Laparoscopic Clip applier 10mm</td><td>Covidien</td><td>176657</td><td>Laparoscopic clip applier</td></tr><tr><td>Laparoscopic sealer/divider, Maryland, curved Jaw</td><td>Covidien</td><td>LF1944</td><td></td></tr><tr><td>Step insufflation/access needle, 100mm</td><td>Covidien</td><td>S100000</td><td>Laparoscopic blunt tip access needle</td></tr><tr><td>Suction irrigation system, battery operated</td><td>McKesson</td><td>250070520</td><td></td></tr><tr><td>Bladeless Trocar, 15mm size, 100mm length</td><td>Covidien</td><td>NB15STF</td><td></td></tr><tr><td>Bladeless Trocar, 12mm size, 100mm length</td><td>Covidien</td><td>NONB12STF</td><td></td></tr><tr><td>Bladeless Trocar, 5mm size, 100mm length</td><td>Covidien</td><td>NONB5STF</td><td></td></tr><tr><td>Bladeless optical trocar, 5mm size, 100mm length</td><td>Covidien</td><td>ONB5STF</td><td></td></tr><tr><td>First Entry Access System, 5x100mm</td><td>Applied Medical</td><td>CTF03</td><td></td></tr><tr><td>Coaxial umbilical cable</td><td>Medtronic</td><td>203CXC</td><td></td></tr><tr><td>Exofin Skin Adhesive</td><td>McKesson</td><td>EX71010</td><td>Skin Adhesive</td></tr><tr><td>Laparotomy sponge, 4&quot;x18&quot;, X-ray and RF-Detectable</td><td>Medtronic</td><td>L041804P01C1</td><td></td></tr><tr><td>Laparoscopic Blade Electrode, 6.5&quot;</td><td>Coviden</td><td>E14506</td><td>Laparoscopic electrocautery blade</td></tr><tr><td>Laparoscopic electrode Flat L-hook</td><td>Covidien</td><td>E3774-36C</td><td>Laparoscopic electrocautery hook</td></tr><tr><td>Banded bag 28&quot;x36&quot;</td><td>McKesson</td><td>13628</td><td>Cover non-sterile equipment in sterle field</td></tr><tr><td>Surgical utility drape with tape</td><td>Medline</td><td>DYNJP2405</td><td>Drapes for sterile field</td></tr><tr><td>Sterile table Drape, 4&#039;</td><td>Grayline Medical</td><td>418HDS</td><td></td></tr><tr><td>OR Fluid warming drape</td><td>Medline</td><td>SDREC44</td><td></td></tr><tr><td>Sterile surgical Leggings 31&quot; W X 48&quot; L</td><td>McKesson</td><td>89408</td><td></td></tr><tr><td>Da Vinci XI Column Drape</td><td>Intuitive Surgical</td><td>470341</td><td>Sterile drape for bedside robot</td></tr><tr><td>Da Vinci XI Arm Drape</td><td>Intuitive Surgical</td><td>470015</td><td>Sterile drape for robotic arms</td></tr><tr><td>Surgical Gown</td><td>McKesson</td><td>41734</td><td></td></tr><tr><td>Endoscopic surgery swab</td><td>Covidien</td><td>173019</td><td>Swab fluid and assist with blunt dissection</td></tr><tr><td>Clean and protect laparoscope lense</td><td>McKesson</td><td>21345</td><td></td></tr><tr><td>Vessel sealer extend</td><td>Intuitive Surgical</td><td>480422</td><td></td></tr><tr><td>Cadiere</td><td>Intuitive Surgical</td><td>471049</td><td></td></tr><tr><td>Fenestrated Bipolar</td><td>Intuitive Surgical</td><td>471205</td><td></td></tr><tr><td>Maryland Bipolar</td><td>Intuitive Surgical</td><td>471172</td><td></td></tr><tr><td>Tip up Grasper</td><td>Intuitive Surgical</td><td>471344</td><td></td></tr><tr><td>Prograsp</td><td>Intuitive Surgical</td><td>471093</td><td></td></tr><tr><td>Hook electrocautery</td><td>Intuitive Surgical</td><td>470183</td><td></td></tr><tr><td>Monopolar curved scissors</td><td>Intuitive Surgical</td><td>470179</td><td></td></tr><tr><td>Large SutureCut needle driver</td><td>Intuitive Surgical</td><td>471296</td><td></td></tr><tr><td>Large needle driver</td><td>Intuitive Surgical</td><td>471006</td><td></td></tr><tr><td>Small grasping forcep</td><td>Intuitive Surgical</td><td>471400</td><td></td></tr><tr><td>Robot Ultrasound Transducer probe</td><td>BK Medical</td><td>8826</td><td>Robotic Drop-in Ultrasound transducer</td></tr><tr><td>2-0 Silk Suture - Cut to 8&quot;</td><td>Ethicon</td><td>K833-H</td><td></td></tr><tr><td>5-0 Polydioxanone RB-2 Cut to 5&quot;</td><td>Ethicon</td><td>Z148-H</td><td></td></tr><tr><td>4-0 V-Loc CV-23 6&quot; x2</td><td>Covidien</td><td>VLOCM0024</td><td></td></tr><tr><td>4-0 Prolene on RB 1</td><td>Ethicon</td><td>8557H</td><td></td></tr><tr><td>3-0 V-LOC V-20 6&quot; x 3</td><td>Covidien</td><td>VLOCM0604</td><td></td></tr><tr><td>0 Vicryl Ties</td><td>Ethicon</td><td>J646H</td><td></td></tr><tr><td>#1 Vicryl Suture</td><td>Medtronic</td><td>CL-64-M</td><td></td></tr><tr><td>4-0 Monocryl</td><td>Ethicon</td><td>Y496G</td><td></td></tr><tr><td>Umbilical tape</td><td>Ethicon</td><td>W276</td><td></td></tr></tbody></table>

robotic-assisted lateral pancreaticojejunostomy for chronic pancreatitis

Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Chronic pancreatitis is a debilitating, benign inflammatory disorder that significantly alters a patient's quality of life. Pancreatic drainage procedures have long been demonstrated to be safe and feasible using laparoscopic and open surgical approaches but have largely been replaced by pancreaticoduodenectomy. Over the past several decades, perioperative outcomes using the robotic platform in hepatobiliary surgery have been rapidly improving and, in many cases, surpassing outcomes in open and laparoscopic approaches. In appropriately selected patients with pancreatic duct obstruction and without an inflammatory mass at the head of the pancreas, there remains a role for parenchymal-sparing operations that relieve recurrent pancreatitis but also limit endocrine and exocrine insufficiency. We present a robotic-assisted lateral pancreaticojejunostomy for a patient with recurrent pancreatitis in the setting of a pancreatic duct stricture. The intention of this manuscript is to provide fellowship-trained hepatobiliary surgeons with a concise and adoptable method for performing robotic-assisted lateral pancreatojejunostomy. This article demonstrates critical aspects of the operation performed in a minimally invasive, robotic fashion to treat recurrent acute/chronic pancreatitis.

This patient had an unremarkable postoperative course with drain amylases decreasing from 139 U/L to 15 U/L anteriorly, and 48 U/L to 13 U/L posteriorly on postoperative days one and three, respectively, indicating no pancreatic leak. His drains were removed at the time of discharge on post-operative Day 4, and he experienced a significant improvement in quality of life with mild intermittent and infrequent pain episodes at two years following surgery. He is not narcotic dependent. The patient's blood glucose remained we...

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.

Chronic pancreatitis is a debilitating, benign inflammatory disorder that significantly alters a patient's quality of life. Pancreatic drainage procedures ...

[Narrator] Here, we present a robotic-assisted lateral pancreatic jejunostomy in a patient with chronic pancreatitis. Our patient is a 39-year-old male with no significant past medical history. He presented to our institution with several episodes of pancreatitis requiring multiple hospitalizations over approximately five years. He had undergone a laparoscopic cholecystectomy several years prior to presentation for a diagnosis of gallstone pancreatitis, however, episodes persisted after surgery and increased in frequency over time. During his workup, he underwent ERCP and endoscopic ultrasound, where he was diagnosed with pancreatic divisum. Additionally, he was found to have a pancreatic duct stricture at the neck, which was unable to be traversed for an attempted pancreatic duct stent placement. On the left is a pancreatogram showing stricturing at the pancreatic duct at the neck with distal dilation. On the right is MRCP showing irregularly dilated pancreatic duct in the body and tail of the pancreas. Given no significant disease of the head of the pancreas or involvement of biliary structures, the patient was deemed a candidate for a drainage procedure. Listed are the steps of the operation, as well as a schematic with suggested port placement for a robotic-assisted lateral pancreatic jejunostomy. At this point in the operation, the lesser sac has been entered. and the stomach is retracted anterior and cephalad, along with the liver. Intraoperative ultrasound is used to identify the dilated pancreatic duct, locate the stricture, and track the course of the duct along the body of the pancreas. The body of the pancreas is incised using cauterized scissors along the anterior surface of the duct. Pancreatic duct fluid is expressed as the duct is entered. A four-French hob stent is used to track the pancreatic duct as it is opened. Identify the ligament of Trietz and proximal jejunum. Approximately 20 centimeters distal to this, a looped jejunum is identified, and using bipolar electrocautery, a mesenteric window is created and the bowel is divided with a 60 millimeter purple load Endo GIA stapler. A retrocolic tunnel in the transverse colon mesentery is created using blunt dissection, and the Roux limb is then subsequently passed through this space into the lesser sac, ensuring that the jejunum reaches the pancreas without tension. A longitudinal enterotomy is created on the antimesenteric aspect of the jejunum using electrocautery and sharp dissection to match the length of the incision along the pancreas. The anastomosis begins at the tail of the pancreas, where two 3-0 V-Loc sutures are anchored at the distal end of the ductotomy and the enterotomy. Each V-Loc suture is run along either side of the anastomosis. A four-French hop stent is used to ensure the duct remains patent at the beginning of the anastomosis. The inferior aspect of the anastomosis is being completed. The anastomosis is completed when the V-Loc sutures meet at the neck of the pancreas, where they are tied together. Here is the completed anastomosis. To complete the operation, GI continuity is reestablished. Small enterotomies are created near the previous stapled edge of the jejunum in a segment of jejunum approximately 50 centimeters distal to the Roux limb. A 60 millimeter purple load Endo GIA staple fire is used to create a side-to-side jejunojejunostomy. The common enterotomy is closed with running 3-0 V-Loc sutures, followed by interrupted 3-0 silk Lembert sutures. 3-0 silk Lembert sutures are again used to close the colon mesenteric defect created around the Roux limb. Two 19-French drains are placed using the robotic port sites. One drain is passed posterior to the pancreatic jejunal anastomosis, and the other anterior to the anastomosis. Here again is the completed anastomosis. His postoperative course was largely unremarkable. He had drained amylase studies indicative of no pancreatic leak. His drains were removed on the day of discharge from the hospital. On his postoperative clinic visit, he reported resolution of preoperative symptoms. Here is a table demonstrating his postoperative outcomes. In this video, we demonstrate that a robotic-assisted modified bestow is a safe and effective option for the treatment of chronic pancreatitis. When used for appropriately selected patients, this option results in symptom control and spares resection of pancreatic parenchyma.

robotic-assisted-lateral-pancreaticojejunostomy-for-chronic

Research

JoVE Journal

Medicine

Laparoscopic pancreatoduodenctomy (LPD) may offer advantages over open pancreatoduodenectomy, including early postoperative mobilization, less delayed gastric emptying and a shorter hospital stay. However, LPD is technically challenging and not well-standardized, especially regarding the pancreatic anastomosis. We describe a standardized technique for the pancreatic anastomosis during LPD: modified Blumgart pancreaticojejunostomy.

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

We describe a new technique for pancreaticojejunostomy reconstruction after pancreaticoduodenectomy that is associated with a very low rate of postoperative pancreatic fistula.

Colonial Wig Pancreaticojejunostomy

The technique of modified single-loop reconstruction following pancreaticoduodenectomy separates pancreatic secretion from bile, thus reducing the severity of POPF without prolonging the duration of surgery.

Modified Single-Loop Reconstruction for Pancreaticoduodenectomy

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

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 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

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A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)

Learn robotic-assisted lateral pancreaticojejunostomy for chronic pancreatitis using minimally invasive techniques. This procedure preserves pancreatic tissue while relieving duct obstruction and improving patient outcomes.

Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis

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