Radiofrequency-based stump management and ductal ablation in robotic central pancreatectomy: a technical note and initial experience.

Abstract

Central pancreatectomy is a parenchyma-sparing procedure for benign or borderline lesions of the pancreatic neck and proximal body but remains associated with high rates of postoperative pancreatic fistula (POPF), largely related to distal remnant management and pancreatico-enteric reconstruction. We describe a novel robotic-assisted technique incorporating radiofrequency (RF)-based stump management combined with endoductal ablation of the main pancreatic duct as a reconstruction-free strategy. This approach is based on our previous preclinical and clinical experience demonstrating that RF-assisted pancreatic transection may improve stump sealing, while ductal ablation induces controlled exocrine atrophy, reducing enzymatic output and potentially mitigating POPF. The technique includes intraoperative ultrasound-guided resection, selective RF application at the transection surface, and intraductal RF ablation using a catheter-based system, without distal pancreatico-enteric anastomosis. Four consecutive patients underwent the procedure. No patient developed POPF or other pancreas-specific complications. This RF-based hybrid strategy represents a biologically driven alternative to conventional reconstruction in central pancreatectomy, with the potential to reduce morbidity while preserving pancreatic parenchyma. These preliminary findings should be regarded as a proof of technical feasibility rather than as evidence of clinical efficacy in reducing POPF, and require validation in larger prospective studies.