Robotic pancreaticoduodenectomy for portal annular pancreas: how to do it

Portal annular pancreas (PAP) is an uncommon anomaly in which the pancreatic parenchyma surrounds the portal or superior mesenteric vein. An adequate operative approach is necessary to prevent clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy for PAP. We herein report a case of robotic pancreaticoduodenectomy for PAP. In PAP, dissection of the retroportal parenchyma is the most important aspect of surgery. Adequate retraction of the portal system using vessel loops allows for a safe dissection and transection of the retroportal parenchyma. The robotic approach has some advantages for dissecting the retroportal parenchyma. The magnified three-dimensional view helps the surgeon distinguish the nerve plexus from the pancreatic parenchyma. The caudal view allows for direct dissection of the retroportal parenchyma from the superior mesenteric artery. Dissection can easily be performed using articulated forceps. Owing to these advantages, robotic pancreaticoduodenectomy can be safely performed for PAP.