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Updated: Sep 9, 2025
Robotic Pancreatoduodenectomy for Pancreatic Head Cancer: a Case Report of a Standardized Technique
Published on: June 24, 2022
Pancreatic head clockwise devascularization technique during robotic pancreaticoduodenectomy to minimize
Kyoji Ito1, Yoshikuni Kawaguchi1, Satoru Abe1
1Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, -3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
Background:
Pancreaticoduodenectomy (PD) is a complex procedure, and robotic PD (RPD) has been reported to have benefits in reducing postoperative complications. However, the timing and order for dividing arteries and veins remain unstandardized. We developed a novel technique, pancreatic head clockwise devascularization, to minimize intraoperative bleeding in RPD.
Methods:
We retrospectively analyzed 39 patients who underwent RPD between April 2022 and September 2024. The clockwise devascularization technique divides 1) the gastroduodenal artery, 2) the 1st-jejunal vein branches, and 3) the inferior pancreatoduodenal artery + 1st-jejunal artery. Outcomes were compared with the conventional superior mesenteric artery (SMA)-first approach.
Results:
Of the 39 patients, 14 were in the clockwise devascularization group and 25 in the SMA-first group. The clockwise group had a significantly shorter operation time (616 vs. 772 min, P < 0.01) and lower blood loss (50 vs. 330 ml, P = 0.03). There were no clinically relevant pancreatic fistulas or delayed gastric emptying in either group. The median hospital stay was shorter in the clockwise group (5.5 vs. 8.0 days, P < 0.01).
Conclusions:
The pancreatic head clockwise devascularization technique may be an effective technique to systematically devascularize the pancreatic head.
