Robotic Total Pancreatectomy: A Novel Pancreatic Head-First Approach (with Video)

Background: The development of the Da Vinci robotic platform has drastically altered the paradigm of minimal invasive pancreatic surgery. However, the evidence of robotic total pancreatectomy (RTP) is still limited. Here we report an alternative approach of RTP, starting with pancreatoduodenectomy (the pancreatic head-first approach). Methods: The patient was a 55-year-old female with a diagnosis of diffuse PNET in the head, body, and tail of the pancreas. The da Vinci Xi robotic system was used for RTP. Our technique of RTP consists of three steps: (1) pancreatoduodenectomy, (2) (en bloc) distal pancreatectomy, and (3) reconstructions. Results: The operative time was 490 min with an estimated blood loss of 100 ml. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Conclusions: RTP is a technically challenging procedure; however, the pancreatic head-first approach of RTP has several advantages.