Beyond Laparoscopy for Pancreatic Surgery in the Caribbean: Robot Assisted Pancreatico-Splenectomy

Abstract

Patients with left-sided pancreatic carcinomas are likely to present with advanced disease. Fewer than 10% of these patients are candidates for operative resection at the time of presentation [1]. Due to the advanced disease stage, there has been a recent shift from the conventional distal pancreatectomy (DP) toward radical antegrade modular pancreatico-splenectomy (RAMPS) for better disease clearance [2]. In the past two decades, we also witnessed a trend toward the use of laparoscopic techniques for left sided pancreatic resections [3-7]. A major limitation, however, is limited maneuverability of straight instruments deep in the retroperitoneum. Robotic systems can overcome this limitation with full articulating wrist movements, thereby facilitating dissections with greater dexterity [8-11]. Full robotic platforms, however, are expensive and are not available in low and middle-income Caribbean nations [12]. In the Anglophone Caribbean, there have been few reports of laparoscopic DP at low volumes [3], but we have encountered no reports of laparoscopic RAMPS in our literature review. We report our initial experience using the FreeHand® robotic camera holder (Freehand 2010 Ltd., Guildford, Surrey, UK) to assist in the completion of laparoscopic RAMPS in Trinidad & Tobago.