Robotic Remnant Total Pancreatectomy After Robotic Pancreaticoduodenectomy (with video)

The number of robotic pancreaticoduodenectomy (R-PD) and robotic distal pancreatectomy (R-DP) procedures has been increasing worldwide. However, there are no reports on clinical cases of robotic remnant total pancreatectomy (R-RTP). This report presents a standardized surgical technique for R-RTP after R-PD based on the authors' experience with three clinical cases. The procedure is presented with accompanying surgical videos, and its feasibility and potential advantages are discussed.

This study presents a standardized surgical technique for R-RTP following R-PD, based on our experience with three clinical cases. The procedure is presented with accompanying surgical videos, and its feasibility and potential advantages are discussed.

The standardized surgical procedure for R-RTP involves patient setting and port placement, intra-abdominal adhesiolysis, dissection of the jejunal loop, encirclement and dissection of the splenic artery and vein, dissection of the dorsal pancreatic border from the retroperitoneum, dissection of the splenocolic ligament and the gastrosplenic ligament, and specimen removal. In this study, the clinicopathologic features and short-term outcomes of the three cases were retrospectively analyzed.

The patients had a mean operative time 332 min (range, 277-425 min), an intraoperative blood loss of 168 mL (range, 50-254 mL), and a postoperative hospital stay of 13.3 days (range, 10-20 days). No postoperative complications or mortality were observed. All the patients achieved pathologic R0 resection and at this writing are alive without recurrence.

This study suggests that R-RTP after R-PD may be technically feasible. The minimally invasive approach, standardization of the surgical procedure, and appropriate metabolic management may contribute to favorable perioperative outcomes and postoperative recovery.