Robotic extended distal pancreatectomy with splenectomy for pancreatic adenocarcinoma

Abstract

Presenter: Sharona Ross MD | AdventHealth Tampa Background: This video describes our technique of an extended distal pancreatectomy for locally advanced post neoadjuvant chemoradiation. Methods: This video is of a 72-year-old woman who presented with epigastric pain and was found to have a pancreatic body mass. Preoperative workup included triple phase CT scan and EUS/FNA showing abutment < 180 degrees of SMV/SMA and encasement of the splenic artery and vein. Patient progressed after 6 months of neoadjuvant chemotherapy and 30 sessions of radiation therapy. Results: The operation began by taking down the gastrohepatic ligament followed by the gastrocolic omentum. The short gastric vessels were taken down and the stomach retracted. An intraoperative ultrasound was utilized to identify the location of the tumor mass and the pancreas was dissected along its inferior edge. The colonic mesentery area along the inferior edge of the pancreas and the common hepatic artery was excised and sent to pathology which returned negative for malignancy. The neck of the pancreas was dissected, and the pancreas was divided with a robotic hook cautery. The left side of the SMV and portal vein was dissected. All the tissue surrounding the celiac trunk, the splenic artery and common hepatic artery were dissected. Next, we arrived at the splenic artery and vein which was divided with two clips on either side. The specimen was removed off the SMV, SMA, portal vein and the celiac trunk. Lastly the pancreas was dissected, medial to lateral, and all the attachments to the spleen were taken down. Conclusion: Operative duration was 3.5 hours with 50 ml of estimated blood loss. Final pathology showed microscopic focus of viable ductal carcinoma of the pancreas in the pancreatic body, associated with extensive fibrosis with zero nodes positive for malignancy. Patient had an uneventful postoperative stay and was discharged on postoperative day 4. This video shows that the robotic approach is safe and efficacious for resection of locally advanced pancreatic carcinoma following neoadjuvant therapy.