A Balduzzi

A Kakita

AA Guzowski

Alfred Cuschieri

AO Whipple

BC Miller

BH Edil

BT Bethea

C Bassi

Caterina Masoni

Desirée Gianardi

EY Kim

G Meccariello

Giulio Di Candio

Gregorio Di Franco

H Kawaida

I Poves

L Morelli

Luca Morelli

M De Pastena

M Kornaropoulos

M Manigrasso

M Olakowski

Matteo Bianchini

Matteo Palmeri

MP Callery

Niccolò Furbetta

PC Giulianotti

R Cirocchi

R Gonzalez-Heredia

SE Wang

Simone Guadagni

SR Grobmyer

T Keck

T Wiggins

Y Cai

Y Lin

YC Shin

English

Background: The treatment of the pancreatic stump is a critical step of pancreatoduodenectomy (PD). Robot-assisted surgery (RAS) can facilitate minimally invasive challenging abdominal procedures, including pancreatojejunostomy. However, one of the major limitations of RAS stems from its lack of tactile feedback that can lead to pancreatic parenchyma laceration during knot tying or during traction on the suture. Moreover, a Wirsung-jejunostomy is not always easy to execute, especially in cases with small diameter duct. Herein, we describe and video-report the technical details of a robotic modified end-to-side invaginated robotic pancreatojejunostomy (RmPJ) with the use of barbed suture instead of the "classical" Wirsung-jejunostomy.Methods: The RmPJ technique consists of a double layer of absorbable monofilament running barbed suture (3-0 V-Loc), the outer layer is used to invaginate the pancreatic stump. Thereafter, a small enterotomy is made in the jejunum exactly opposite to the location of the pancreatic duct for stent insertion (usually 5 Fr) inside the duct. The internal layer provides a second barbed running suture placed between the pancreatic capsule/parenchyma and the jejunal seromuscular layer.Results: A total of 14 patients underwent robotic PD with RmPJ at our Institution. The mean console time was (281.36 ± 31.50 min), while the mean operative time for fashioning the RmPJ was 37.31 ± 7.80 min. Ten out of 14 patients were discharged within postoperative day 8. No clinically relevant pancreatic fistulas were encountered, while two patients developed biochemical leaks.Conclusions: RmPJ is feasible and reproducible irrespective of pancreatic duct size and parenchyma, and can enhance the surgical workflow of this operation. Specifically, the use of barbed sutures allows the exploitation of the potential advantages of the RAS, while minimizing the negative effect caused by the main disadvantage of the robotic approach, its absence of tactile feedback, by ensuring uniform tension on the continuous suture lines used, especially during the reconstructive phase of the operation.</p

Morelli, Luca

Furbetta, Niccolò

Gianardi, Desirée

Guadagni, Simone

Di Franco, Gregorio

Bianchini, Matteo

Palmeri, Matteo

Masoni, Caterina

Di Candio, Giulio

Cuschieri, Alfred

Discovery Research Portal

Use of barbed suture without fashioning the "classical" Wirsung-jejunostomy in a modified end-to-side robotic pancreatojejunostomy

Crossref

Use of barbed suture without fashioning the “classical” Wirsung-jejunostomy in a modified end-to-side robotic pancreatojejunostomy

https://discovery.dundee.ac.uk/files/52329212/Morelli2020_Article_UseOfBarbedSutureWithoutFashio.pdf

Use of barbed suture without fashioning the "classical" Wirsung-jejunostomy in a modified end-to-side robotic pancreatojejunostomy

Abstract

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Discovery Research Portal