Novel single-layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Abstract

Introduction: Robotic pancreaticoduodenectomy (RPD) is one of the most technically challenging procedures in robotic abdominal surgery. The best technique for pancreatic anastomosis after PD remains controversial, and the procedure for performing this anastomosis by a robotic approach has not been previously reported. This study aimed to evaluate the safety and feasibility of a novel technique of pancreaticojejunostomy (PJ) for RPD. Method: The demographics and perioperative outcomes of a consecutive series of RPD patients who underwent single-layer continuous suture (SCS) for PJ between September 2018 and November 2018 were analyzed. Result: Thirty patients (19 men and 11 women; mean age, 55.0 years) were included in the study. Twenty patients had a soft pancreas, and 15 patients had a small main pancreatic duct (MPD) (<3 mm). The mean operative time was 234.1 minutes, the mean duration of PJ was 14.9 min, and the median estimated blood loss was 100.0 mL (interquartile range, 50-150 mL). No patients required conversion to laparotomy or a blood transfusion. Postoperative major morbidities (Clavien ≥C) occurred in 3 patients (10%), and all recovered after conservative treatment. The overall incidence of postoperative pancreatic fistula was 30% and included 7 cases (23.2%) of Grade A, 2 cases (6.7%) of Grade B, and no case of Grade C pancreatic fistula. The mean postoperative hospital stay was 12.3 days. No 90-day readmission mortality or 90-day mortality was observed. Neither pancreatic texture nor MPD size affected the perioperative outcomes. Conclusion: SCS is a safe and feasible PJ technique for RPD. SCS is easy to perform and is associated with favorable clinical outcomes, regardless of the pancreatic duct size and texture.