A stepwise approach to totally robotic pancreas-sparing duodenectomy with intracorporeal duodenojejunostomy

While pancreaticoduodenectomy is the standard for duodenal malignancy, pancreas-sparing duodenectomy (PSD) is a surgical option for benign duodenal disease. Robotic surgery for PSD offers advantages, such as enhanced visualization, improved instrument dexterity, and optimized dissection, while maintaining resection quality. After preoperative imaging review, we performed a totally robotic PSD with intracorporeal duodenojejunostomy in a 70-year-old patient with a 2.2-cm sessile polyp and dysplasia in the D3 portion of the duodenum. Although PSD is not indicated for malignancy, a negative intraoperative frozen section is critical before proceeding in select cases. A key learning point is combining robotic visualization with upper endoscopy to accurately define the distance between the ampulla and the lesion, ensuring oncologic margins. This manuscript outlines a stepwise surgical approach in a technically challenging scenario, aiming to preserve patient safety and provide an oncologically sound resection using totally robotic techniques.