Robotic Central Pancreatectomy with Omental Pedicle Flap: Tactics and Tips.

Abstract

Background: Robotic central pancreatectomy is increasingly used for pre- or low-grade malignant tumors in the pancreatic body balancing preservation of pancreatic function while removing the target lesion.^1-3 Today, there is no established reconstruction method and high rates of postpancreatectomy fistulas (POPF) remain a significant concern. ^4,5 We developed novel technique involving transgastric pancreaticogastrostomy with an omental pedicle advancement flap to reduce the risk of POPF. Additionally, preoperative deep-learning 3D organ modeling plays a crucial role in enhancing spatial understanding to enhance procedural safety.^6,7 METHODS: A 76-year-old female patient with a 33-mm, biopsy-confirmed high-risk IPMN underwent robotic-assisted central pancreatectomy. Preoperative CT was processed with a deep-learning system to create a patient-specific 3D model, enabling virtual simulation of port configurations. The optimal setup was selected based on the spatial relationship between port site, tumor location, and anatomy A transgastric pancreaticogastrostomy with omental flap reinforcement was performed to reduce POPF leading to a simpler reconstruction compared to pancreaticojejunostomy. The procedure lasted 218 min with minimal blood loss (50 ml). No complications occurred, and the patient was discharged on postoperative Day 3 after drain removal. Final pathology showed low-grade dysplasia.

Conclusions: This approach, facilitated by robotic assistance, effectively preserves pancreatic function while treating a low-grade malignant tumor. Preoperative 3D organ modeling enhances the spatial understanding with the goal to increase procedural safety. Finally, the omental pedicle advancement flap technique shows promise in possibly reducing the incidence or at least the impact of POPF.