Robotic uncinate enucleation with transmesenteric sleeve duodenectomy: a novel approach

Enucleation is a well-known parenchymal sparing technique for resecting benign tumors of the pancreas. Lesions on the pancreas' anterior surface allow for a straightforward enucleation approach. Lesions in the uncinate process, however, can be quite challenging to access through standard open and laparoscopic approaches compared to a robotic approach. The uncinate process is the part of the pancreas that bends backwards and beneath the body of the pancreas. Furthermore, this area is where the superior mesenteric artery and the superior mesenteric vein (SMV) intersect. Visualization of the uncinate process from a minimally invasive approach is limited by the cranio-caudal view of the camera; this tumor location makes the standard supramesocolic approach to the pancreas very difficult. Therefore, in this paper, we describe a novel technique to robotic pancreatic enucleation of the uncinate via a transmesenteric approach. An associated sleeve duodenectomy, which is resection of the duodenum in a sleeve fashion to allow for jejunal anastomosis, is also performed for reconstruction in this operation. This novel approach to pancreatic enucleation provides better visualization with faster recovery times compared to traditional laparoscopic and open methods. Our main contribution is to allow surgeons to replicate this technique for tumors of this type and location for this preferred technique.