Robotic pylorus preserving pancreaticoduodenectomy with mini-laparotomy reconstruction in patient with ampullary adenoma.

Robotic surgical system provides many unique advantages which might compensate the limitations of usual laparoscopic surgery. By using robotic surgical system, we performed robot-assisted laparoscopic pancreaticoduodenectomy (PD). A Sixty-two year old female patient with an ampullary mass underwent robot assisted PD due to imcomplete treatment of endoscopic ampullectomy. The removal of specimen and reconstruction were performed through small upper midline skin incision. Robot working time was about 8 hours, and blood loss was about 800 ml without blood transfusion. She returned to an oral diet on postoperative day 3. Grade B pancreatic leak was noted during the postoperative period, but was successfully managed by conservative management alone. We successfully performed da Vinci-assisted laparoscopic PD, and robot surgical system provided three-dimensional stable visualization and wrist-like motion of instrument facilitated complex operative procedures. More experiences are necessary to address real role of robot in far advanced laparoscopic pancreatic surgery.