Robotic fluorescence-guided bile duct preserving pancreatic head resection with splanchnic

This video was entered by Dr. Raja Kalayarasan in the 2022 KS International Robotic Surgery Innovation Awards, sponsored by the Vattikuti Foundation. It was featured in the Vattikuti Symposium ‘Humans at the Cutting Edge of Robotic Surgery,’ held in Miami, Florida November 19, 2022.

Full Title:

Robotic fluorescence-guided bile duct preserving pancreatic head resection with splanchnic neurectomy for chronic pancreatitis
Kalayarasan R, Additional Professor & Head, Department of Surgical Gastroenterology, JIPMER, Puducherry, India

Introduction: Most of the reported series on minimally invasive approaches for chronic pancreatitis (CP) have focussed on the feasibility of laparoscopic lateral pancreaticojejunostomy or modified Frey’s procedure. As the pancreatic head is the pacemaker of pain in CP patients, adequate resection and decompression of the pancreatic head is critical. Also, the neurological component of pain plays a vital role in a subset of CP patients. A novel technique of fluorescence-guided robotic bile duct preserving pancreatic head resection with splanchnic neurectomy described here accomplishes both objectives.

Methods: Key steps of the procedure are entry to lesser sac and control of the gastrocolic trunk,
exposure of suprapancreatic portal vein, division of anterosuperior pancreaticoduodenal artery, and separation of gastroduodenal artery from the pancreatic surface, transection of the pancreatic neck, resection of the pancreatic head from the pancreatic capsule, fluorescence- guided preservation of bile duct and division of pancreatic duct at its junction with the bile duct. During the thoracic phase, greater, lesser, and least splanchnic nerves are resected. Results: A 26-year-old female with idiopathic CP and three years of abdominal pain underwent this procedure. The duration of surgery and blood loss were 350 minutes and 200 mL, respectively. The patient had an uneventful postoperative course and was discharged on the fifth postoperative day.

Results: Robotic fluorescence-guided bile duct preserving pancreatic head resection with
splanchnic neurectomy is a feasible procedure for CP patients. The current procedure’s superiority over existing CP procedures needs to be evaluated in more studies.

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