Skip to main content
SpringerLink
Log in

Development of the Robotic Approach to Pancreaticoduodenectomy

  • Chapter
  • First Online:
Minimally Invasive Surgical Techniques for Cancers of the Gastrointestinal Tract

  • 796 Accesses

Abstract

Though minimally invasive approaches have been readily incorporated into many areas of oncologic surgery, their use for pancreaticoduodenectomy (PD) has been less widespread. However, with the introduction of a robotic platform, surgeons have been able to overcome the technical challenges that limited the adoption of laparoscopic PD. Robotic PD (RPD) can now be performed with the same safety and oncologic outcome profile as open PD and is the preferred surgical approach in our institution. Here, we describe our technique for RPD, which separates the procedure into seven component steps: mobilization, dissection of the porta hepatis and pancreatic neck, uncinate process dissection, gallbladder removal, pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763–79.

    Article  CAS  Google Scholar 

  2. Whipple AO. Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet. 1946;82:623–31.

    CAS  PubMed  Google Scholar 

  3. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.

    Article  CAS  Google Scholar 

  4. Palanivelu C, Rajan PS, Rangarajan M, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepato-Biliary-Pancreat Surg. 2009;16:731–40.

    Article  CAS  Google Scholar 

  5. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy. Arch Surg. 2010;145:19–23.

    Article  Google Scholar 

  6. Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010;24:1646–57.

    Article  Google Scholar 

  7. Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections. Ann Surg. 2013;258:554–9.

    Google Scholar 

  8. Gagner M, Pomp A. Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg. 1997;1:20–5; discussion 25-6.

    Google Scholar 

  9. Gagner M, Gentileschi P. Hand-assisted laparoscopic pancreatic resection. Semin Laparosc Surg. 2001;8:114–25.

    Article  CAS  Google Scholar 

  10. Hanly EJ, Talamini MA. Robotic abdominal surgery. Am J Surg. 2004;188:19–26.

    Article  Google Scholar 

  11. Zeh HJ, Bartlett DL, Moser AJ. Robotic-assisted major pancreatic resection. Adv Surg. 2011;45:323–40.

    Article  Google Scholar 

  12. Gagner M, Palermo M. Laparoscopic Whipple procedure: review of the literature. J Hepato-Biliary-Pancreat Surg. 2009;16:726–30.

    Article  Google Scholar 

  13. Nguyen KT, Zureikat AH, Chalikonda S, et al. Technical aspects of robotic-assisted pancreaticoduodenectomy (RPD). J Gastrointest Surg. 2011;15:870–5.

    Article  Google Scholar 

  14. Boone BA, Zenati M, Hogg ME, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy. JAMA Surg. 2015;150:416.

    Article  Google Scholar 

  15. Hogg ME, Tam V, Zenati M, et al. Mastery-based virtual reality robotic simulation curriculum: the first step toward operative robotic proficiency. J Surg Educ. 2017;74:477–85.

    Article  Google Scholar 

  16. Tam V, Zenati M, Novak S, et al. Robotic pancreatoduodenectomy biotissue curriculum has validity and improves technical performance for surgical oncology fellows. J Surg Educ. 2017;74(6):1057–65.

    Google Scholar 

  17. Zureikat AH, Postlewait LM, Liu Y, et al. A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg. 2016;264:640–9.

    Article  Google Scholar 

  18. Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.

    Article  Google Scholar 

  19. Evans DB, Farnell MB, Lillemoe KD, et al. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1736–44.

    Article  Google Scholar 

  20. Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.

    Article  Google Scholar 

  21. Cunningham KE, Zenati MS, Petrie JR, et al. A policy of omitting an intensive care unit stay after robotic pancreaticoduodenectomy is safe and cost-effective. J Surg Res. 2016;204:8–14.

    Article  Google Scholar 

  22. Molinari E, Bassi C, Salvia R, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg. 2007;246:281–7.

    Article  Google Scholar 

  23. Ecker BL, McMillan MT, Allegrini V, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy. Ann Surg. 2019;269(1):143–9.

    Google Scholar 

  24. Cameron JL, Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–5.

    Article  Google Scholar 

  25. Hatzaras I, Schmidt C, Klemanski D, et al. Pancreatic resection in the octogenarian: a safe option for pancreatic malignancy. J Am Coll Surg. 2011;212:373–7.

    Article  Google Scholar 

  26. Makary M, Winter J, Cameron J, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56.

    Article  Google Scholar 

  27. McMillan MT, Zureikat AH, Hogg ME, et al. A propensity score–matched analysis of robotic vs open pancreatoduodenectomy on incidence of pancreatic fistula. JAMA Surg. 2017;152:327–35.

    Article  Google Scholar 

  28. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.

    Article  Google Scholar 

  29. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH)–an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.

    Article  Google Scholar 

  30. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  Google Scholar 

  31. Lee JH, Hwang DW, Lee SY, et al. Clinical features and management of pseudoaneurysmal bleeding after pancreatoduodenectomy. Am Surg. 2012;78:309–17.

    Article  Google Scholar 

  32. Eppsteiner RW, Csikesz NG, McPhee JT, et al. Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg. 2009;249:635–40.

    Article  Google Scholar 

  33. Schmidt CM. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after Pancreaticoduodenectomy. Arch Surg. 2010;145:634.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Patrick Varley, Amr Al-Abbas & Melissa E. Hogg

Authors
  1. Patrick Varley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amr Al-Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa E. Hogg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melissa E. Hogg .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Joseph Kim

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Julio Garcia-Aguilar

Electronic Supplementary Material

Robotic technique for the pancreaticoduodenectomy. In this video, the seven steps for a completely robotic pancreaticoduodenectomy are demonstrated: (1) mobilization, (2) portal dissection, (3) uncinate dissection, (4) cholecystectomy, (5) pancreaticojejunostomy, (6) hepaticojejunostomy, and (7) gastrojejunostomy (MP4 1039351 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Varley, P., Al-Abbas, A., Hogg, M.E. (2020). Development of the Robotic Approach to Pancreaticoduodenectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Minimally Invasive Surgical Techniques for Cancers of the Gastrointestinal Tract. Springer, Cham. https://doi.org/10.1007/978-3-030-18740-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-18740-8_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18739-2

  • Online ISBN: 978-3-030-18740-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation