Challenging dissection during a robotic Whipple procedure extended to the pancreatic body

Abstract

Presenter: Valentina Valle | University of Illinois at Chicago Background: Intraductal Papillary Mucosal Neoplasm (IPMNs) are lesions with malignant potential. The indication to resection is based on size of the lesion and symptoms. Minimally invasive robotic pancreatic surgery is expanding. Here we present a challenging case of a pancreaticoduodenectomy extended to the body of the pancreas for multiple IPMN lesions. Methods: A 68 year-old female presented with epigastric pain radiating to the back and recurrent chronic pancreatitis. A MRI showed 3 cm pancreatic head lesion and 2 cm pancreatic body lesion concerning for main duct IPMN. Based on size of the lesion and patient symptoms, robotic assisted surgical resection was offered. Extensive adhesiolysis was required to expose the surgical area. Delicate maneuvers allowed a safe dissection of a very difficult uncinate process anatomy. Results: The patient underwent elective surgery for her pancreatic cystic mucinous tumors. The operative time was 450 minutes. Blood loss was 150 cc. Post-operative course was uneventful and the patient was discharged on post-operative day 8. Conclusion: Robotic platform is a valuable tool for complex pancreatic surgery even in the presence of adhesions and challenging scenarios.