Use of an Externalized Pancreatic Stent During Robotic Pancreaticoduodenectomy

Postoperative pancreatic fistula (POPF) is a major contributor to morbidity and mortality after pancreaticoduodenectomy (PD)¹. Externalized pancreatic stents decrease the incidence and severity of POPF after PD^2-6, but their feasibility has not been demonstrated in robotic PD. We present our method of externalized pancreatic stent placement during robotic PD and report our initial experience.

This video demonstrates our technique of using an externalized pancreatic stent during robotic PD. We conducted a retrospective review of patients who underwent robotic PD with externalized pancreatic duct stent placement at a single academic institution. Fistula risk was graded using the Fistula Risk Score (FRS)⁷ and the Alternative FRS⁸, and postoperative outcomes were recorded.

Of 67 consecutive patients, 44.8% were female and the median age was 68 years. The most common indication for PD was pancreatic ductal adenocarcinoma (PDAC) (47.8%), followed by cystic neoplasms (22.4%) and neuroendocrine tumors (11.9%); 75% of patients with PDAC received neoadjuvant chemotherapy for borderline resectable disease, and 21.9% underwent preoperative radiation. Most (70.1%) had an intermediate risk of POPF using FRS, and 19.4% were classified as high risk based on the Alternative FRS. The overall POPF rate was 17.9% (biochemical leak⁹ 16.4%; grade B 1.5%; grade C 0%). The median length of stay was 5 days, and the 90-day readmission rate was 22.4%. Stents were removed, on average, at 29 days postoperatively.

We report the placement of an externalized pancreatic stent during robotic PD, which has not been previously described in robotic surgery. This method is technically feasible and is associated with very low rates of fistula-related complications.