Robotic artery-first approach during pancreatoduodenectomy

Abstract

Presenter: Fabio Makdissi MD | Nove de Julho Hospital Background: Surgical resection along with adjuvant or neoadjuvant chemotherapy is the only curative modality for the treatment of patients with pancreatic and periampullary tumors. With the increasing use of minimally invasive techniques, laparoscopic and robotic pancreatoduodenectomy (PD) has become more common, but laparoscopic artery-first techniques have only been described by a few studies. The aim of this study is to describe our robotic artery-first technique. Methods: Video clips were compiled from several robotic PD to demonstrate the artery-first technique. This technique consists of early retroperitoneal dissection of the superior mesenteric artery from pancreatic head. Results: There were 73 patients who underwent robotic PD at our center between March 2018 and August 2020. Of these, 24 patients underwent the robotic artery-first approach. The indication for its use was proximity of the tumor to the portal vein or SMV in six cases. In three cases, partial resection of the porto-mesenteric axis was necessary, and the artery-first approach allowed for safe venous resection and reconstruction. In three other cases, the tumor was in close contact with the vein, but it could be resected with free margins without venous resection. In the last 18 patients, the approach was systematically used regardless of the tumor’s proximity to the porto-mesenteric axis. Conclusion: This robotic artery-first approach is feasible and safe for PD. The approach could facilitate robotic PD, and its systematical use could provide some important advantages during the resection phase. The videos could also help HPB surgeons to perform this complex yet important maneuver.