Robotic total pancreatectomy with splenectomy for multifocal intraductal papillary mucinous neoplasm

Abstract

Objective: In this video, we describe a systematic approach to a robotic total pancreatectomy for multifocal intraductal papillary mucinous neoplasm (IPMN) involving the entire pancreas. Methods: The patient is a 61-year-old female with a history of stage I endometrial cancer post robotic assisted total hysterectomy and salpingo-oophorectomy who was diagnosed with multifocal IPMN. Endoscopic ultrasound with fine needle aspiration of a complex cyst at the pancreas neck was significant for a CEA of 2080. She is a type 1 diabetic on an insulin pump. Results: A total of 6 robotic ports were placed and the da Vinci Xi robotic system was used with the patient supine. The approach entailed: (i) Diagnostic laparoscopy (ii) Entry into the lessec sac (iii) Division of the short gastric vessels (iv) Exposure and dissection of the inferior pancreas border (v) Dissection and transection of the splenic artery (vi) Mobilization of the spleen (vii) Exposure of the splenic vein-superior mesenteric vein confluence and transection of the splenic vein (viii) Kocher maneuver (ix) Release of the Treitz and transection of proximal jejunum (x) Transection of the distal stomach (xi) Portal lymphadenectomy (xii) Dissection and transection of the gastroduodenal artery (xiii) Hepaticojejunostomy (xiv) Cholecystectomy (xv) Gastrojejunostomy. Conclusion: Robotic total pancreatectomy with splenectomy offers a minimally invasive approach to a major abdominal operation and is feasible in a stepwise, reproducible technique.