How do it: tips and tricks during full-robotic pancreaticoduodenectomy.

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Robotic pancreaticoduodenectomy (RPD) is gaining acceptance as a standard surgical procedure.
• Its minimally invasive approach offers advantages over open surgery, including reduced blood loss and quicker patient recovery.

Purpose of the Study:

• To present practical tips and tricks for optimizing robotic pancreaticoduodenectomy.
• To focus on critical aspects such as pancreatic and biliary reconstruction, vascular protection, and drainage system placement.

Main Methods:

• Detailed description of techniques for managing pancreatic and biliary sections during RPD.
• Application of the falciform ligament for vascular protection during the procedure.
• Strategies for precise positioning of drainage systems and modified anastomosis techniques.

Main Results:

• Implementation of specific techniques, including 4/0 PDS stitches for bleeding control and avoiding energy use during dissection to prevent ischemia.
• Use of a modified Blumgart anastomosis and hydrogel sheets to minimize pancreatic fistula formation.
• Anticipated reduction in the incidence and severity of postoperative pancreatic fistula (POPF) and bleeding.

Conclusions:

• The presented tips and tricks can significantly improve surgical outcomes in RPD.
• These practical strategies aim to enhance patient recovery and reduce postoperative complications.
• The study contributes valuable insights for the routine clinical application of RPD.