Huscher modified technique for robotic pancreaticojejunostomy: a video report.

Abstract

Pancreaticojejunostomy (PJ) is a critical step in pancreaticoduodenectomy (PD), often complicated by the risk of postoperative pancreatic fistula (POPF). This video report demonstrates a novel robotic PJ technique employing a self-expandable metallic stent. The method involves the use of the Da Vinci Xi robotic system and the WallFlex™ Biliary RX Stent for improved anastomotic support, particularly in high-risk cases defined by soft pancreatic texture and narrow duct diameter (<3 mm). Key steps include precise deployment of the self-expandable stent using a modified Seldinger technique and completion of the anastomosis with barbed sutures. The self-expandable stent dynamically adapts to the pancreatic duct, reducing tension and enhancing ductal drainage during the critical postoperative period, without requiring balloon expansion or fluoroscopy. This innovation addresses limitations associated with traditional stents and facilitates robotic procedures. Compared to Huscher's use of coronary artery stents (CAS), this technique offers simplicity and adaptability to minimally invasive settings. Outcomes of the robotic PJ approach highlight potential benefits, including reduced POPF rates and improved anastomotic precision. The integration of barbed sutures enhances efficiency and reproducibility, though considerations of pancreatic tissue fragility remain essential. This report underscores the feasibility and advantages of combining advanced robotic surgery with innovative stenting techniques to optimize outcomes in pancreatic surgery.