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Robotic resection of the uncinate process of the pancreas
- Source :
- Journal of robotic surgery. 13(5)
- Publication Year :
- 2018
-
Abstract
- Since the development of the robotic platform, the number of robotic-assisted surgeries has significantly increased. Robotic surgery has gained growing acceptance in recent years, expanding to pancreatic resection. Here, we report a total robotic resection of the uncinate process of the pancreas performed in a patient with a cystic neuroendocrine tumor. To our knowledge, this is the first report of a robotic resection of the uncinate process of the pancreas. A 46-year-old man with no specific medical history was diagnosed with a neuroendocrine tumor after undergoing routine imaging. Biopsy guided by echoendoscopy revealed a well-differentiated neuroendocrine tumor. We decided to perform a robotic resection of the uncinate process of the pancreas after obtaining informed consent for the procedure. According to preoperative echoendoscopy and magnetic resonance imaging, there was a safe margin between the neoplasm and the main pancreatic duct. The technique uses five ports. The duodenum is fully mobilized, and Kocher maneuver is carefully performed. The uncinate process of the pancreas is then identified. The resection of the uncinate process begins with the division of small arterial branches from the inferior pancreaticoduodenal artery in its inferior portion, followed by control of venous tributaries to the superior mesenteric vein. Intraoperative localization of the ampulla of Vater is performed using indocyanine green enhanced fluorescence, thus defining the superior margin of the uncinate process. The pancreatic division is made about 5 mm below its upper margin for safety. Surgical specimen is then retrieved through the umbilical port inside a plastic bag. The raw pancreatic area is covered with hemostatic tissue and drained. The total operation time was 215 min. The docking time was 8 min and console time was 180 min. Blood loss was minimum, estimated at less than 50 mL. The postoperative period was uneventful, except for hyperamylasemia in the drain fluid. The patient was discharged on the 3rd postoperative day. The final pathological report confirmed well-differentiated pancreatic neuroendocrine tumor. Robotic resection of the uncinate process of the pancreas is safe and feasible, providing parenchymal conservation in a minimally invasive setting. Robotic resection should be considered for patients suffering from low-grade pancreatic neoplasms located in this part of the pancreas.
- Subjects :
- Male
medicine.medical_specialty
Operative Time
030232 urology & nephrology
Health Informatics
03 medical and health sciences
0302 clinical medicine
Pancreatectomy
Robotic Surgical Procedures
medicine.artery
Biopsy
medicine
Humans
Robotic surgery
Superior mesenteric vein
Pancreas
Neoplasm Staging
Pancreatic duct
medicine.diagnostic_test
business.industry
Ampulla of Vater
Inferior pancreaticoduodenal artery
Margins of Excision
Middle Aged
Pancreatic Neoplasms
Neuroendocrine Tumors
medicine.anatomical_structure
Treatment Outcome
030220 oncology & carcinogenesis
Duodenum
Surgery
Radiology
business
Organ Sparing Treatments
Subjects
Details
- ISSN :
- 18632491
- Volume :
- 13
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of robotic surgery
- Accession number :
- edsair.doi.dedup.....dbbd01296b80bfc6cdcc8fd6a46853e4