Intraoperative Pancreatoscopy Demonstrates Feasibility of Pancreatic Preservation During Robotic Pancreatoduodenectomy for IPMN in Elderly Patients.

BACKGROUND

Main duct intraductal papillary mucinous neoplasm (MD-IPMN) carries a substantial risk of malignant transformation and often requires surgical resection.1,2 Preservation of the remnant pancreas remains an important goal, particularly in elderly patients.3,4 Therefore, determining the optimal extent of resection requires a careful balance between oncological safety and preservation of pancreatic function.5,6 The utility of intraoperative pancreatoscopy during robotic pancreatoduodenectomy (RPD) for this purpose has not been well established.7

METHODS

We present two elderly patients with MD-IPMN who underwent RPD combined with intraoperative pancreatoscopy. After pancreatic transection, a Spyglass was introduced through a robotic port #1 and advanced into the remnant pancreatic duct under robotic guidance. The main pancreatic duct and branch ducts were systematically inspected for findings suspicious for high-grade dysplasia or skip lesions.8 Frozen-section analysis of the pancreatic margin was performed in both cases.

RESULTS

The patients were in their 70s with pancreatic head IPMN and pancreatic duct dilation. Intraoperative pancreatoscopy demonstrated no suspicious lesions within the remnant pancreas. Frozen-section analysis confirmed the absence of carcinoma or high-grade dysplasia at the pancreatic margin. Based on these findings, no additional pancreatic resection was required, and the remnant pancreas was preserved in both patients. Final pathology revealed mixed-type IPMN with high-grade dysplasia and no invasive carcinoma in both cases.

CONCLUSIONS

Intraoperative pancreatoscopy can be safely integrated into RPD and serves as an adjunct to preoperative imaging, potentially facilitating targeted biopsy. This approach may support preservation of the remnant pancreas in elderly patients with MD-IPMN.