Robotic resection and reconstruction of the superior mesenteric vein without graft during pancreatoduodenectomy

Presenter: Fabio Makdissi MD | Sírio Libanês Hospital Background: Pancreatoduodenectomy is the procedure of choice for resectable tumors located in head pancreas. Invasion major vessels, particularly portal and superior mesenteric vein a relative contraindication minimally invasive approach. We present video robotic resection reconstruction without use graft during pancreatoduodenectomy. Methods: A 56-year-old female, with one week history jaundice, referred treatment. CT scan showed 3 cm tumor endoscopic ultrasound contact SMV. Endoscopic biopsy confirmed ductal adenocarcinoma. Multidisciplinary team decided upfront surgery. Robotic approach was proposed, consent obtained. Superior artery first used to release pancreas way that whole surgical specimen only attached by invasion vein. After partial SMV, its extension precluded lateral suture transverse anastomosis (Clavien-Rudiger technique) necessary minimize risk narrowing completion venous anastomosis, alimentary tract done as usual. Results: Operative time 430 minutes. Time clamping 30 minutes SMV suture: 23 Estimated blood loss 370 mL no transfusion. Pathology T3N1 adenocarcinoma free margins. Recovered uneventfully discharged on 7th postoperative day. Only biochemical leak observed. Conclusion: safe feasible pylorus-preserving pancreatoduodenectomy patients but not encasing or The proposed technique should be cases where requires extended precludes simple suture.