{"title":"How do it: tips and tricks during full-robotic pancreaticoduodenectomy.","authors":"T Piardi, G Badessi, S A Biondo, C Del Basso","doi":"10.1007/s13304-025-02264-4","DOIUrl":null,"url":null,"abstract":"<p><p>Robotic pancreaticoduodenectomy (RPD) is increasingly recognized as a standard procedure due to its minimally invasive nature and associated benefits such as reduced blood loss and faster recovery. This paper presents a set of tips and tricks, focusing on the management of pancreatic and biliary sections, the application of the falciform ligament for vascular protection, and the precise positioning of drainage systems. Key strategies include the use of 4/0 PDS stitches to control pancreatic vessel bleeding, preventing ischemia by refraining from the use of energy during pancreas dissection, and ensuring optimal drainage placement. The incorporation of a modified Blumgart anastomosis with a single-thread technique and the use of hydrogel sheets are also highlighted as crucial in reducing fistula formation. We think that these measures can significantly lower the incidence and severity of POPF and postoperative bleeding, thereby enhancing surgical outcomes. This paper aims to contribute to the growing body of knowledge on RPD, offering practical tips that can be safely and effectively integrated into routine clinical practice.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Updates in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13304-025-02264-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Robotic pancreaticoduodenectomy (RPD) is increasingly recognized as a standard procedure due to its minimally invasive nature and associated benefits such as reduced blood loss and faster recovery. This paper presents a set of tips and tricks, focusing on the management of pancreatic and biliary sections, the application of the falciform ligament for vascular protection, and the precise positioning of drainage systems. Key strategies include the use of 4/0 PDS stitches to control pancreatic vessel bleeding, preventing ischemia by refraining from the use of energy during pancreas dissection, and ensuring optimal drainage placement. The incorporation of a modified Blumgart anastomosis with a single-thread technique and the use of hydrogel sheets are also highlighted as crucial in reducing fistula formation. We think that these measures can significantly lower the incidence and severity of POPF and postoperative bleeding, thereby enhancing surgical outcomes. This paper aims to contribute to the growing body of knowledge on RPD, offering practical tips that can be safely and effectively integrated into routine clinical practice.
期刊介绍:
Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future.
Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts.
Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.