Robotic Duodenum-preserving Total Pancreatic Head Resection for Intraductal Papillary Mucinous Neoplasms
April 17th, 2026
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.
Introduction.Robotic duodenum-preserving total pancreatic head resection has many advantages over traditional pancreaticoduodenectomy in treating pancreatic cystic neoplasms, particularly intraductal papillary mucinous neoplasms.Protocol. Patient selection. Here we report a 65-year-old male patient diagnosed as intraductal papillary mucinous neoplasm by contrast enhanced computed tomography presenting as a 4.3 centimeter cystic solid mass with mural nodule in the pancreatic head.
Operative setting. after the pneumoperitoneum is created following the five port technique to settle the trocars. Exploration phase.
Incise the gastrocolic ligament inferior to the gastroepiploic vessels to open the lesser sac. Mobilize the stomach and pancreas. Reevaluate the lesion.
Decide to conduct total duodenum-preserving pancreatic head resection. Dissection phase. Open the Kocher maneuver same as pancreaticoduodenectomy.
Dissect along the inferior border of pancreas. Identify trunk of Henle along the superior mesenteric vein tributaries. Dissect and divide the right gastroepiploic vein.
Lymphadenectomy of the lymph node group 8. Assess the extent of resection. Mark the border of transection.
Transect the pancreas anterior to the portal vein. Avoid using electrocautery instruments to handle main pancreatic duct. Resect the margin of main pancreatic duct for frozen section pathology.
Surround the superior mesenteric vein with a vascular retraction tape. Pull the tape to suspend superior mesenteric vein. Dissect along the superior mesenteric artery and the gastroduodenal artery on the anterior right border.
Inject indocyanine green intravenously 30 minutes before imaging. Try to locate the common bile duct. Expose the inferior pancreaticoduodenal artery on the right side of superior mesenteric artery and superior mesenteric vein.
Shut down the branches entering the tumor from inferior pancreaticoduodenal artery. Dissect distally along the gastroduodenal artery. Protect the common bile duct all the time.
With help of indocyanine green imaging. Suture-ligate tumor-feeding vessels from the anterior superior pancreatic pancreaticoduodenal artery. Resect the margin of main pancreatic duct for frozen section pathology.
Separate the tumor along the upper border of pancreas. Sacrifice the interior superior pancreaticoduodenal artery if necessary. Resect the pancreatic head and uncinate process, containing the lesion totally.
Remove the surgical specimen inside a retrieval bag. Image with indocyanine green again to confirm the integrity of common bile duct. Reinforce the vascular stumps.
Reconstruction phase. Incise the ligament of Treitz. Transect the jejunum 20 centimeters from the ligament of Treitz using linear cutter stapler.
Lift the distal jejunum posterior to the colon. Pass through the pancreas from the ventral to the dorsal side. Suture to the seromuscular layer of the jejunum using 3-0 barbed sutures.
Create a hole full-thickness through the jejunum. Perform a duct-to-mucosa anastomosis with interrupted 5-0 PDSs. Place a two times four millimeters internal stent into the main pancreatic duct.
Suture the ventral seromuscular layer of the jejunum to the ventral side of the pancreas. Complete the knotting with the dorsal side suture. 40 centimeters distal to the previous anastomosis.
Perform a side-to-side enterostomy using an electric cutting stapler. Close the common opening with 3-0 barbed sutures. Close the mesenteric defects.
Place drains near the anastomosis and pancreatic stump. Complete the procedure and close the incisions.Results. Postoperative pathology revealed intraductal papillary mucinous neoplasm.Conclusion.
Robotic total duodenum-preserving pancreatic head resection is a minimally invasive procedure for benign or low-grade malignant tumors of the pancreatic head. It can be an organ-preserving alternative to pancreaticoduodenectomy under specific conditions. This procedure should be performed by well-trained surgeons with extensive experience in robotic and pancreatic surgery.
View the full transcript and gain access to thousands of scientific videos
Overview
This protocol demonstrates robotic duodenum-preserving total pancreatic head resection (R-DPPHRt) for intraductal papillary mucinous neoplasms (IPMNs). It showcases the technique's feasibility as a minimally invasive, organ-preserving alternative to pancreaticoduodenectomy.
Key Study Components
Area of Science
- Cancer Research
- Robotic Surgery
- Pancreatic Surgery
Background
- Intraductal papillary mucinous neoplasms are cystic tumors of the pancreas.
- Traditional treatments often involve extensive surgical procedures.
- Robotic techniques may offer advantages in surgical precision and recovery.
- Duodenum-preserving approaches aim to reduce postoperative complications.
Purpose of Study
- To present a minimally invasive surgical technique for IPMNs.
- To evaluate the feasibility of robotic duodenum-preserving resection.
- To provide an alternative to pancreaticoduodenectomy.
Methods Used
- Patient selection based on imaging and diagnosis.
- Robotic surgical techniques for dissection and resection.
- Use of indocyanine green for imaging during surgery.
- Reconstruction techniques following resection.
Main Results
- Postoperative pathology confirmed the diagnosis of IPMN.
- The procedure demonstrated feasibility in a clinical setting.
- Minimally invasive approach may lead to better recovery outcomes.
- Organ preservation was achieved in the surgical technique.
Conclusions
- Robotic total duodenum-preserving pancreatic head resection is a viable option.
- This technique is suitable for benign or low-grade malignant tumors.
- It should be performed by experienced surgeons in robotic and pancreatic surgery.
