Robotic Double Purse-String Telescoped Pancreaticogastrostomy: How I Do It
Some articles have recently shown that robotic pancreaticoduodenectomy (PD) is feasible and can be a safe method. On the other hand, pancreatic fistulas (PF) remain the most dreaded complication after PD, and a secured pancreaticoenteric reconstruction may be essential in this regard. Previous articles have highlighted the usefulness of telescoped pancreaticogastrostomy (PG) in open PD to reduce the risk of postoperative PF. Additionally, in 2016, Addeo et al. described a double purse-string telescoped PG (DPS-PG), simplified from previous techniques, with favorable short-term results.
Materials and methods
The attached video reports our standardized technique for robotic DPS-PG, which is based on Addeo’s approach. The main characteristic of this technique is an easy placement of two seromuscular purse-string sutures without the need for gastric wall dissection or deep pancreatic parenchymal sutures. We modified and developed Addeo’s technique to suit the robotic PD. In our robotic DPS-PG, there is no need to perform the opening of the distal gastric stump, the anterior gastrostomy, or the suture fixation of the pancreatic parenchyma to the stomach, as it could lead to a rupture of the pancreas, particularly when the parenchyma is soft.
We consider that our technique of robotic DPS-PG might be feasible and can be safely performed, just as a previously described technique in open surgery.
Further evaluation with clinical trials is required to validate its real benefits.
The authors are grateful to Iana Shutrova, Christopher Burel and Guy Temporal for their assistance in proofreading the manuscript, as well as to Catherine Cers for her digital illustrations, which serve as schematics in the present article.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
Supplementary material 1 (MP4 176299 kb)