Robotic Pancreas Resection

Abstract

Summary: All minimally invasive pancreatic resections have been performed using conventional laparoscopic techniques. In purely resective procedures (e.g. distal pancreatectomy with en-bloc splenectomy) laparoscopy is enough in most patients, as witnessed also by the growing diffusion of this procedure. On the contrary, the intrinsic limitations of laparoscopy become evident when fine intracorporal dissections and multiple intracorporeal reconstructions are need, such as in pancreatoduodenectomy. Indeed, although feasible, laparoscopic pancreatoduoden­ectomy has not gained widespread popularity and has instead been associated with high morbity rates.

Robotic surgery is a variation of laparoscopic surgery that employs an electromechanical actuator, the da Vinci Surgical System® to enhance surgical dexterity in minimally invasive procedures. As such, robotic surgery in pancreatic procedures is expected to be particularly rewarding in pancreatoduodenectomy, in central pancreatectomy and in distal pancreatectomy when preservation of the spleen along with the splenic vessels is anticipated to be difficult or troublesome. In my talk I will present the results of some 400 robotic pancreatectomies and will provide a sketch on how our program was developed and attained standardizaion for all types of pancreatic procedures, including those that may require resection and reconstruction of the superior mesenteric/portal vein.