Novel methods for robotic pancreaticojejunostomy: stapler closure of branched pancreatic duct and local staples removal to prevent postoperative pancreatic fistula during robotic pancreaticoduodenectomy.

BACKGROUND

Postoperative pancreatic fistula (POPF) is considered to be a cause of morbidity and mortality following pancreaticoduodenectomy (PD). Currently, no reconstructive technique perfectly prevents POPF. Robotic surgery has many advantages and may enhance reconstructive surgery. Here, we describe the technical details of our robotic pancreaticojejunostomy (RPJ) method, which contains closure of branched pancreatic duct using stapler and local staples removal around the main pancreatic duct (MPD).

METHODS

The study retrospectively analyzed 30 consecutive patients who underwent robotic PD (RPD) with RPJ at our institute. We evaluated short-term perioperative results by comparing RPD to open PD (OPD), and analyzed technique-related outcomes by dividing patients into three groups: First and last groups, thin MPD (MPD≦2.1 mm) and thick MPD (MPD > 2.1 mm) groups, and soft pancreas and hard pancreas groups.

RESULTS

The clinically relevant POPF (CR-POPF) rate for our methods was 3.3%. Compared to OPD, CR-POPF tended to be lower in patients with soft pancreas (4.8 vs. 14.3%, p = 0.36). The median RPJ time was 57.1 min, with staple removal around MPD taking 7 min. The total time of pancreatic duct and jejunal mucosa anastomosis (33.3 vs 26.2 min, p = 0.01) and overall time (61.6 vs 54.6 min, p = 0.006) were shorter in the last term group. The time of continuous suture of posterior wall of MPD (17.6 vs 11.9 min, P = 0.006) and fixation of lost stent (2.0 vs 1.7 min, P = 0.041) were shorter in the MPD > 2.1 group. No significant differences were observed between soft pancreas and hard pancreas groups.

CONCLUSIONS

Our RPJ technique demonstrates a very low incidence of POPF. This method leverages the full advantage of robotic surgery, including a stable, magnified operative field and precise, multi-joint instrument manipulation, to improve surgical outcomes.