monthly focus

surgical intervention video

We report the case of a robot-assisted pancreaticoduodenectomy for vaterian ampulloma. The patient is positioned in the French position with the assistant between the legs and the robot at the head. Five trocars are used: the camera is introduced through the umbilical trocar. The operation begins with the exploration of the peritoneum and of the liver. The gastric antrum is divided. Each structure of the hepatic pedicle is skeletonized. The superior border of the pancreas is dissected, hence allowing to approach the mesentericoportal axis. 

The surgeon proceeds to the inferior border of the pancreas in order to find the mesentericoportal axis and to achieve a retropancreatic passage, which is where the pancreas will be divided. The pancreas is divided using the Sonicision™ cordless ultrasonic dissection device. The first jejunal loop is divided with a stapler. The specimen is totally mobilized ‘en bloc’, and freed from the portal vascular axis with a dissection of the right border of the coeliac trunk. At the end of the dissection, the different arterial and venous structures are skeletonized with a lymph node resection. The reconstruction is performed with a pancreaticogastrostomy, hepaticojejunostomy, and gastrojejunostomy. 

Robotic pancreaticoduodenectomy for vaterian ampulloma

Duodenopancreatectomía para carcinoma de la ampolla de Vater (ampuloma)


Pancréaticoduodénectomie par voie robotique pour ampullome de Vater


Duodenopancreatectomia para carcinoma da ampola de Vater (ampuloma)


机器人胰头十二指肠切除术治疗食管壶腹部肿瘤


Робот-ассистированная панкреатодуоденальная резекция по поводу опухоли фатерова соска


Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method. 

 

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor. 

 

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1. 

 

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.

Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure

Anastomoses laparoscópicas com sutura manual totalmente intracorpóreas durante procedimento Whipple


Anastomosis laparoscópicas con sutura manual totalmente intracorpóreas durante procedimiento de Whipple


Anastomoses par sutures manuelles et complètement intracorporelles pendant intervention de whipple


完全手工吻合在腹腔镜惠普尔手术植骨


Полное интракорпоральное ручное формирование анастомозов при выполнении операции Уиппла


video lecture

Методы лапароскопической пакреатодуоденэктомии


Pancréatoduodénectomie laparoscopique : technique


Nesta palestra magistral, o Dr. Asbun descreve a história e a justificativa da cirurgia pancreática laparoscópica e da sobrevivência no câncer de pâncreas. Ele compara a duodenopancreatectomia laparoscópica com a duodenopancreatectomia aberta e apresenta um panorama das complicações com exemplos de estudos de caso. Demonstra os princípios básicos, as dicas técnicas e os passos-chave da técnica com ilustrações em vídeo. Fornece uma breve descrição da hepatojejunostomia, da pancreatojejunostomia e da duodenojejunostomia pós-pilórica. E enfatiza que a abordagem laparoscópica é segura e factível.


Duodenopancreatectomia laparoscópica: técnica

In this key lecture, Dr. Asbun describes the history and rationale of laparoscopic pancreatic and survival in pancreatic cancer. He compares laparoscopic pancreatoduodenectomy to open pancreatoduodenectomy, and he gives an overview of complications with examples of case studies. He demonstrates the main principles, technical tips, and key steps of the technique with video illustrations. He provides a brief description of hepatojejunostomy, pancreaticojejunostomy, and post-pyloric duodenojejunostomy. He stresses that the laparoscopic approach is safe and feasible. 

Laparoscopic pancreatoduodenectomy: technique

Focus on Laparoscopic Duodenopancreatic Surgery

Focus sur la chirurgie duodénopancréatique laparoscopique


В центре внимания - лапароскопическая хирургия двенадцатипёрстной кишки и поджелудочной железы
