Robotic pancreatic necrosectomy and internal drainage for walled-off pancreatic necrosis

Abstract

BackgroundPancreatic necrosectomy with concomitant internal drainage is a single-stage treatment option for walled-off pancreatic necrosis (WOPN). However, an optimal minimally invasive technique has not been established. We evaluated the safety and single-intervention success rate of robotic pancreatic necrosectomy and internal drainage. MethodsPatients with WOPN undergoing robotic pancreatic necrosectomy and internal drainage at a single institution from 2011-2022 were identified. The primary outcome was the rate of clinical symptom resolution following the index surgical intervention. Results57 patients underwent robotic pancreatic necrosectomy and internal drainage, consisting of robotic cystgastrostomy (RCG, n = 37), robotic cystjejunostomy (RCJ, n = 13) and robotic fistulojejunostomy (RFJ, n = 7). Surgery was performed a median of 102 (range 28–1153) days following the onset of necrotizing pancreatitis. The median operative time was 187 (91–344) minutes and there were 2 (3.5%) conversions. The median length of hospital stay was 4 (2–38) days. Postoperative morbidity was 11%, and there was one (1.8%) 90-day mortality. At a median follow-up of 5.5 months, 53 (93%) patients had clinical symptom resolution after their index procedure and did not require any reintervention. ConclusionIn select patients, robotic pancreatic necrosectomy and internal drainage is safe and achieves a high single-intervention success rate.