Jejunum Patch Technique During Robot-Assisted Central Pancreatectomy: A Lesson from Open Procedure Experience.

Background: Central pancreatectomy (CP) has been established as the most common type of parenchyma-sparing pancreatectomy; however, CP is associated with higher morbidity and a higher pancreatic fistula (PF) rate than distal pancreatectomy or pancreaticoduodenectomy. The jejunum patch technique (JPT) for distal pancreatectomy has recently been applied, which efficiently decreases the incidence of PF. We have adapted this technique to CP as well as distal pancreatectomy with celiac axis resection. Here, we retrospectively evaluated the usefulness of JPT for open CP cases, and report the experience of robot-assisted CP using the JPT.

Methods: Among 37 consecutive cases who underwent CP at our institution between 2011 and 2022, clinical characteristics and postoperative short-term outcomes were compared between patients who underwent CP with and without the JPT. In robot-assisted CP using the JPT, after resection of the middle of the pancreas the transected jejunum was elevated through the retrocolic route in a Roux-en-Y fashion. The pancreatic stump was covered by the JPT using a modified Blumgart technique, following pancreaticojejunostomy for the distal side. RESULTS: Among the entire cohort, 19 patients underwent CP using the JPT. The clinically relevant PF rate of the JPT group was significantly lower (47.4%) than the no-JPT group (83.3%, p = 0.022), and the length of drainage and hospital stay were shorter in the JPT group (p= 0.010 and p = 0.017, respectively). The blood loss of robot-assisted CP using the JPT was 20 mL, and the JPT took only 15 min.

Conclusion: Robot-assisted CP using the JPT is an easy-to-use and promising procedure, based on experience and outcomes from open surgery.