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Robotic pancreaticoduodenectomy for vaterian ampulloma
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.
P Pessaux, R Memeo, V De Blasi, D Mutter, J Marescaux
Surgical intervention
3 years ago
2792 views
244 likes
0 comments
28:02
Robotic pancreaticoduodenectomy for vaterian ampulloma
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.
Full laparoscopic pancreaticoduodenectomy for malignant ampulloma
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.
A Talvane Torres de Oliveira, C Lacerda, PA Bertulucci
Surgical intervention
7 years ago
7887 views
86 likes
1 comment
40:39
Full laparoscopic pancreaticoduodenectomy for malignant ampulloma
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.