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Review
. 2023 Dec;93(12):2897-2903.
doi: 10.1111/ans.18719. Epub 2023 Oct 5.

Robotic enucleation & uncinectomy of complex lesions of the proximal pancreas

Nicholas Bell-Allen  1 , Bartholomew McKay  1 , Daniel Kilburn  1 , Peadar Waters  1   2 , David Cavallucci  1
Affiliations
Review

Robotic enucleation & uncinectomy of complex lesions of the proximal pancreas

Nicholas Bell-Allen et al. ANZ J Surg. 2023 Dec.

Abstract

Background: Malignant tumours within the proximal pancreas traditionally require pancreaticoduodenectomy (PD) for cure. For smaller lesions with borderline malignant potential the risk/benefit of PD becomes difficult to justify. Robotic approaches to these lesions allow for parenchymal preserving resection with reduced complication profile without oncological compromise.

Methods: A review of a single surgeons prospectively collated database across two institutions of consecutive robotic enucleations or parenchyma preserving resections of the proximal pancreas was performed between July 2018 and October 2021. Standard demographic data, preoperative variables, intraoperative parameters, post-operative outcomes, morbidity and mortality were recorded.

Results: Thirteen patients (8 female and 5 male) underwent robotic enucleation (EN) (8) and/or uncinectomy (UN) (5) in the proximal pancreas. Mean BMI was 32(kg/m2 ). Three patients (21%) underwent preoperative prophylactic pancreatic duct stenting. One patient required conversion to open. The median operative time in the EN group was 170 min (108-224 min) and the UN group was 160 min (110-204 min). The majority (8) of lesions were pNETs. Three lesions were IPMNs, with 1 solitary fibrous tumour and a serous cystic neoplasm (SCN) respectively. Median tumour size was 23 mm (11-58 mm) in the EN group, and 27 mm (17-38 mm) in the UN group. Ten of 13 patients had an R0 resection. There was no mortality in our series. Four (31%) patients across both groups developed clinically relevant POPF while none developed new endocrine or exocrine insufficiency. Average outpatient follow-up has been 6 months (1-18 months).

Conclusion: A robotic approach in proximal parenchymal preserving pancreatectomy is expanding, safe and feasible.

Keywords: enucleation; pancreas; parenchyma preserving; proximal; robotic; uncinectomy.

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