How I Do It: Robotic Pancreaticoduodenectomy

Excerpt

Minimally invasive pancreaticoduodenectomy (Whipple procedure) has been described by several groups with favorable outcomes; however, this procedure has not been widely adopted for a variety of reasons.^1‐7 The most significant barrier to its adoption is the technical skill level required to perform critical portions of the resection and reconstruction by using conventional laparoscopic instruments. We lack solid, scientific evidence (randomized controlled trials) to support the transition from an open to minimally invasive approach for Whipple procedures, and we have a long way to go as a surgical community in terms of validating this technique. Although many pancreatic surgeons cite this as a reason for not adopting a laparoscopic approach, it is plausible that they lack the technical training to perform critical steps of the procedure laparoscopically. From our perspective, we would not attempt a laparoscopic Whipple procedure, because we lack the technical capacity to perform many steps of the procedure with the same skill and precision that we have when performing an open pancreaticoduodenectomy (PD), using 2.5x loupes. This admission of humility, an attribute at variance among surgeons, led us to the use of robotics systems (daVinci Surgical System®, Intuitive Surgical, Sunnyvale, CA) in order to overcome the barriers of performing a minimally invasive Whipple procedure and my own limitations. …