Biography
Biography: Sharona Ross
Abstract
This video documents a robotic pancreaticoduodenectomy and cholecystectomy undertaken in a 70-year-old man. The patient presented upon transfer with painless jaundice and unintentional weight loss. Preoperative workup included a contrast enhanced CT scan, EGD (Esophagogastroduodenoscopy), Endoscopic ultrasound (EUS) and Fine needle aspiration (FNA) and Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. An 8 mm trocar was placed through the umbilicus for the robotic camera and two 8 mm robotic ports were placed at the right and left midclavicular lines on the same level as the umbilicus. A fourth 8 mm robotic port was placed at the left anterior axillary line halfway between the level of the umbilicus and the costal margin. Finally, an Advanced Access Gelport® was placed between the midclavicular line and the umbilicus and an AirSeal® Access Port at the right anterior axillary line. The gastrohepatic omentum was opened in a stellate fashion. The Kocher maneuver was undertaken, and the jejunum was transected using a robotic stapling device. The dissection continued along the gastrocolic omentum and the duodenum was transected just distal of the pylorus. The pancreatic neck was divided, and dissection continued along the uncinate process of the pancreas. A cholecystectomy was performed, and the distal common bile duct was transected. A laparoscopic EndoCatch bag was used to extract the specimen through the Advanced Access Gelport®. Reconstruction was initiated with a single-layer hepaticojejunostomy anastomosis followed by a two-layer pancreaticojejunostomy anastomosis. A single-layer duodenojejunostomy was constructed just distal to the pylorus. Finally, a Jackson Pratt drain was placed prior to closure. The patient tolerated the operation well and was discharged on day 3 following postoperation.