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The robotic Whipple: operative strategy and technical considerations

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Abstract

Advances in robotic surgery have allowed the frontiers of minimally invasive pancreatic surgery to expand. We present a step-by-step approach to the robotic Whipple procedure. The discussion includes port setting and robotic docking, kocherization and superior mesenteric vein identification, portal dissection, releasing the ligament of Treitz, uncinate dissection, and reconstruction. A brief report of our initial 2-year experience with the robotic Whipple procedure is also presented.

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References

  1. Giulianotti PC, Sbrana G, Bianco FM et al (2010) Robotic-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657

    Article  PubMed  Google Scholar 

  2. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138(7):777–784

    Article  PubMed  Google Scholar 

  3. Bilimoria KY, Talamonti MS, Sener SF, Bilimoria MM, Stewart AK, Winchester DP, Ko CY, Bentrem DJ (2008) Effect of hospital volume on margin status after pancreaticoduodenectomy for cancer. J Am Coll Surg 207(4):510–519

    Article  PubMed  Google Scholar 

  4. Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA (2006) Volume and process of care in high-risk cancer surgery. Cancer 106(11):2476–2481

    Article  PubMed  Google Scholar 

  5. Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA (2009) Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg 250(1):159–165

    Article  PubMed  Google Scholar 

  6. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232(6):786–795

    Article  PubMed  CAS  Google Scholar 

  7. Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM (2009) The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg 208(4):528–538

    Article  PubMed  Google Scholar 

  8. Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, Pitt HA, Tielsch JM, Cameron JL (1998) Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 228(3):429–438

    Article  PubMed  CAS  Google Scholar 

  9. Teh SH, Diggs BS, Deveney CW, Sheppard BC (2009) Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch Surg 144(8):713–721

    Article  PubMed  Google Scholar 

  10. Pawlik TM, Gleisner AL, Cameron JL, Winter JM, Assumpcao L, Lillemoe KD, Wolfgang C, Hruban RH, Schulick RD, Yeo CJ, Choti MA (2007) Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 141(5):610–618

    Article  PubMed  Google Scholar 

  11. Schwarz RE, Smith DD (2006) Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol 13(9):1189–1200

    Article  PubMed  Google Scholar 

  12. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD (2000) Resected adenocarcinoma of the pancreas - 616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4(6):567–579

    Article  PubMed  CAS  Google Scholar 

  13. Pancreatic Adenocarcinoma. NCCN clinical practice guidelines in oncology—V.2.2010. www.NCCN.org

  14. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13

    Article  PubMed  Google Scholar 

  15. Strasberg SM, Linehan DC, Clavien PA, Barkun JS (2007) Proposal for definition and severity grading of pancreatic anastomosis failure and pancreatic occlusion failure. Surgery 141(4):420–426

    Article  PubMed  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  18. Strasberg SM, Ludbrook PA (2003) Who oversees innovative practice? Is there a structure that meets the monitoring needs of new techniques? J Am Coll Surg 196(6):938–948

    Article  PubMed  Google Scholar 

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Correspondence to Shawn MacKenzie.

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MacKenzie, S., Kosari, K., Sielaff, T. et al. The robotic Whipple: operative strategy and technical considerations. J Robotic Surg 5, 3–9 (2011). https://doi.org/10.1007/s11701-010-0216-9

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  • DOI: https://doi.org/10.1007/s11701-010-0216-9

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