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Robotic and Laparoscopic Pancreaticoduodenectomy: A Hybrid Approach

Narula, Vimal K. MD; Mikami, Dean J. MD; Melvin, W. Scott MD

doi: 10.1097/MPA.0b013e3181bd604e
Original Articles
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Objectives: Minimally invasive surgery is beneficial for complex operations; robotics may improve performance in these procedures; however, robotic pancreaticoduodenectomy (PD) has been plagued by long operative times. We describe a small series (n = 5) of patients who underwent a hybrid PD for treatment of obstructive jaundice and pancreatic mass.

Methods: After diagnostic laparoscopy, the gallbladder was retracted cephalad and the porta hepatis was dissected. The lesser sac was opened to expose the superior mesenteric vein below the pancreas. Once the vein was cleared, the bile duct, stomach, pancreas, and jejunum were transected. After the uncinate process was cleared, the specimen was removed. The da Vinci S Surgical Robotic System was docked to perform a mucosa-to-mucosa pancreaticojejunostomy and an end-to-side choledochojejunostomy. A stapled gastrojejunostomy and drain placement completed the operation.

Results: Five patients underwent hybrid PD between May 2006 and June 2007. All patients had a history of pancreatitis and presented with obstructive jaundice and a pancreatic mass. The operations were completed with 5 ports. The mean operative time was 7 hours. The mean hospital stay was 9.6 days. At 6 months after the operation, all patients were disease-free.

Conclusions: Complex procedures such as PD can be accomplished with minimally invasive surgical techniques using robotic instrumentation.

From the Division of General and Gastrointestinal Surgery, Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University Medical Center, Columbus, OH.

Received for publication May 22, 2008; accepted June 17, 2009.

Reprints: Vimal K. Narula, MD, Department of Surgery, The Ohio State University Medical Center, N723 Doan Hall, 410 W 10th Ave, Columbus, OH 43210-1228 (e-mail: raaja.narula@osumc.edu).

© 2010 Lippincott Williams & Wilkins, Inc.