Total pancreatectomy (TP) is a complex pancreatic procedure that has regained acceptance in the recent years due to progress in diabetic management and better understanding of pancreatic pathophysiology and tumor biology. Although advance in critical care medicine and innovation in surgical techniques have contributed to improved outcomes in TP patients, surgical morbidities remain significant with the traditional laparotomy approach. The idea of applying minimally invasive surgery to TP began taking shape following laparoscopic cholecystectomy success. However, with inherent limitations of non-wristed laparoscopic instruments, two-dimensional view, and unnatural hand-eye coordination, laparoscopic TP has been limited to only few highly skilled laparoscopic-pancreatic surgeons. The advent of the dVSS provided a better MIS alternative that has allowed more pancreatic surgeons to perform complex MI pancreatic surgeries including TP.
However, combining robotic approach to TP increases another layer of difficulty to an already complex procedure, particularly in the preoperative planning stage. Because TP is a biquadrant procedure, it presents a strategic challenge in terms of the robot setup and positioning – whether it should be single docked or double docked. There are also tactical issues and debates ranging from fully robotic versus hybrid, single surgeon versus co-surgeons, instrumentation, and technical steps. As such, to date, there is yet a uniformed agreement as to what is the standard robotic TP approach. This chapter presents an RTP technique that utilizes, in majority of the cases, a single docking and a solo-surgeon approach by a fellowship trained and experienced high-volume pancreatic surgeon.
Robotic pancreatectomy Total pancreatectomy Robotic total pancreatectomy Spleen-preserving total pancreatectomy Pyloric sparing total pancreatectomy The da Vinci robotic surgical system The da Vinci Si The da Vinci Xi Intuitive Surgical Inc. Minimally invasive pancreatectomy Laparobotic pancreatectomy
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