Multimedia ArticleRobotic Radical Antegrade Modular Pancreatosplenectomy Using the Supracolic Anterior Superior Mesenteric Artery Approach
Introduction
Radical antegrade modular pancreatosplenectomy (RAMPS) is the standardized approach in open pancreatic resection for pancreatic body and tail cancer to achieve R0 resection and radical lymphadenectomy.1,2 Despite recent development of minimally invasive pancreas resection,3,4 few literatures have reported regarding robotic RAMPS for pancreatic cancer.5 The present study demonstrates our standardized techniques of robotic RAMPS using the supracolic anterior superior mesenteric artery (SMA) approach with the ventral view.
Section snippets
Case
The patient was a 75-year-old female with a diagnosis of pancreatic body cancer. After neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel, robotic RAMPS was performed. The operative time was 251 min with an estimated blood loss of 10 mL. The uneventful postoperative course was observed with the postoperative hospital stay of 8 days. The final pathology confirmed R0 surgical resection.
Indication for Robotic RAMPS
Tumor diagnosed as stage T1–3 with no distant metastases according to the AJCC TNM staging system is an indication for robotic RAMPS. Tumors involving the celiac axis (CA), SMA, superior mesenteric vein (SMV), or common hepatic artery are excluded from robotic RAMPS.
Surgical Techniques
Our standardized techniques of robotic RAMPS using the da Vinci Si robotic system can be simply divided into four steps (Supporting Video 1). Four robotic trocars were placed at the umbilical level, and two trocars (5 mm and 10 mm) for an assistant were inserted as demonstrated in Fig. 1. Thereafter, the robotic cart was docked head-on.
Discussion
The present report describes our standardized techniques of robotic RAMPS using the supracolic anterior SMA approach with the ventral view. It has been reported that laparoscopic RAMPS is difficult to perform due to technical difficulties of medial approach in laparoscopic surgery.2 Therefore, the ligament of Treitz approach and the caudo-dorsal artery first approach have been proposed to determine the posterior margin of the pancreas.6,7 In contrast, the ventral view in robotic surgery is
Conclusions
Robotic RAMPS using the supracolic anterior SMA approach with the ventral view is safe and feasible for pancreatic body and tail cancer to obtain negative tangential margins. This approach is helpful in performing robotic RAMPS. In addition, it is essential to understand anatomical structures precisely.
Acknowledgements
We express our gratitude to Kenjiro Kumano for his suggestions of drawings in this report.
japan society for the promotion of science21K16447 Kosei Takagi
Funding
Financial support was received from Japan Society for the Promotion of Science (grant number 21K16447).
Declarations
Ethics Approval and Consent to Participate
Because this was a single report, and not a trial or observational research, there was no requirement for ethical approval.
Conflict of Interest
The authors declare no competing interests.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in
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