AI Article Synopsis
- - Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard for patients who respond to neoadjuvant therapies, and the feasibility of robotic pancreatoduodenectomy with vein resection (RPD-VR) has been demonstrated, yet detailed challenges have not been thoroughly addressed.
- - The study outlines various vascular techniques adopted from OPD-VR and robotic transplant procedures, providing a detailed classification of vein resections into four types, with video demonstrations of each.
- - Out of 783 pancreatoduodenectomies performed over 13 years, 36 were RPD-VR, showing a 90-day mortality of 8.3% and low conversion to open surgery
Article Abstract
Background: Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study provided a detailed description of the technical challenges associated with this formidable operation. Herein, we describe the trips and tricks for technically successful RPD-VR.
Methods: The vascular techniques used in RPD-VR were borrowed from OPD-VR, as well as from our experience with robotic transplantation of both kidney and pancreas. Vein resection was classified into 4 types according to the international study group of pancreatic surgery. Each type of vein resection was described in detail and shown in a video.
Results: Between October 2008 and November 2021, a total of 783 pancreatoduodenectomies were performed, including 233 OPDs-VR (29.7%). RPD was performed in 256 patients (32.6%), and RPDs-VR in 36 patients (4.5% of all pancreatoduodenectomies; 15.4% of all pancreatoduodenectomies with vein resection; 14.0% of all RPDs). In RPD-VR vein resections were: 4 type 1 (11.1%), 10 type 2 (27.8%), 12 type 3 (33.3%) and 10 type 4 (27.8%). Vascular patches used in type 2 resections were made of peritoneum (n = 8), greater saphenous vein (n = 1), and deceased donor aorta (n = 1). Interposition grafts used in type 4 resections were internal left jugular vein (n = 8), venous graft from deceased donor (n = 1) and spiral saphenous vein graft (n = 1). There was one conversion to open surgery (2.8%). Ninety-day mortality was 8.3%. There was one (2.8%) partial vein thrombosis, treated with heparin infusion.
Conclusions: We have reported 36 technically successful RPDs-VR. We hope that the tips and tricks provided herein can contribute to safer implementation of RPD-VR. Based on our experience, and according to data from the literature, we strongly advise that RPD-VR is performed by expert surgeons at high volume centers.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10082118 | PMC |
| http://dx.doi.org/10.1007/s00464-022-09860-0 | DOI Listing |
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