Jejunum Patch Technique During Robot-Assisted Central Pancreatectomy: A Lesson from Open Procedure Experience

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Central pancreatectomy (CP) is a common parenchyma-sparing procedure but has higher morbidity and pancreatic fistula (PF) rates than other pancreatectomies.
• The jejunum patch technique (JPT) has shown promise in reducing PF after distal pancreatectomy and has been adapted for CP.
• This study evaluates the efficacy of JPT in open CP and reports initial experience with robot-assisted CP using JPT.

Purpose of the Study:

• To retrospectively evaluate the usefulness of the jejunum patch technique (JPT) for open central pancreatectomy (CP).
• To report the initial experience and outcomes of robot-assisted CP using the JPT.

Main Methods:

• A retrospective comparison of 37 consecutive CP cases (2011-2022) with and without JPT.
• Robot-assisted CP with JPT involved Roux-en-Y reconstruction with the pancreatic stump covered by JPT using a modified Blumgart technique.
• Outcomes assessed included clinically relevant PF rate, drainage duration, and hospital stay.

Main Results:

• Nineteen patients underwent CP with JPT. The JPT group had a significantly lower clinically relevant PF rate (47.4%) compared to the no-JPT group (83.3%, p=0.022).
• Patients in the JPT group experienced shorter drainage duration (p=0.010) and hospital stays (p=0.017).
• Robot-assisted CP with JPT demonstrated minimal blood loss (20 mL) and a short operative time for the JPT (15 min).

Conclusions:

• The jejunum patch technique (JPT) is effective in reducing pancreatic fistula rates and improving short-term outcomes in central pancreatectomy.
• Robot-assisted CP using the JPT is a feasible, easy-to-use, and promising procedure.
• The technique builds upon successful outcomes from open surgery, suggesting broader applicability.