The Three-Point Gastric Retraction Technique (3P-GRT) for Enhanced Surgical Field Exposure in Robotic Distal Pancreatectomy

Abstract

Introduction

Robotic distal pancreatectomy (RDP) is increasingly performed for tumors of the pancreatic body and tail, offering reduced blood loss and faster recovery. However, prolonged operative time and higher costs remain challenges. Effective gastric retraction is critical for smooth surgical manipulation during RDP.

Surgical Technique

We developed the Three-Point Gastric Retraction Technique (3P-GRT). The greater omentum is incised to release the omental bursa, and the gastro-splenic ligament is divided to mobilize the stomach. The first fixation sutures the gastric antrum to the abdominal wall, exposing the pancreatic body. The second fixation secures the posterior gastric fundus, enhancing access to the gastro-pancreatic mesentery. The third fixation uses robotic-assisted traction on the left gastric artery pedicle, providing adjustable retraction. This approach achieves stable, wide exposure from the pancreatic body to the tail, enabling smooth and efficient surgical maneuvers.

Operative Results

Eight consecutive patients underwent RDP with 3P-GRT. Median operative time was 282 min and median blood loss was 25 mL. All procedures were completed safely without complications attributable to the technique.

Conclusion

The 3P-GRT provides simple, reproducible gastric retraction, facilitating stable pancreatic exposure and efficient operative workflow in RDP.