Page 30 - World Association of Laparoscopic Surgeons - Journal

WJOLS

Role of Robotics in Whipple’s Surgery

A B
Figs 3A and B: Creation of the retropancreatic tunnel, along the anterior border of the superior mesenteric vein and portal vein
confluence. Dissection is completed under direct visualization, which is facilitated by the position of the robotic camera. Completing
the tunnel under direct visualization improves the safety of the Whipple procedure 10

A B
Figs 4A and B: (A) Elevation of the pancreatic head and uncinate process in an anterior fashion out of the retroperitoneum.
The superior mesenteric vein and portal vein confluence is visualized in the center of the photograph. The elevation of the pancreatic
tissue allows excellent visualization of the uncinate process and its retroperitoneal attachments. (B) As the uncinate process is
mobilized from the retroperitoneum, the Wrst jejunal vein branch must be anticipated. The photograph illustrates the 1st jejunal vein,
with the vein branch entering the inferior portion of pancreatic head 10

LITERATURE REVIEW
Whipple procedure remains a standard surgical procedure
for periampullary carcinoma. 16
Since the first laparoscopic cholecystectomy in 1989,
minimally invasive surgery has become the alternative
approach to conventional open surgery in many abdominal
procedures. 17 In early laparoscopic years, most surgeons
used only diagnostic laparoscopy to evaluate periampullary
18
malignancies or staging pancreatic cancer. With the benefit
of minimal invasive surgery and new advances in technology
and instrumentation, some surgeons began to apply it to
more sophisticated procedures such as Whipple procedure. 19
Fig. 5: Suturing of the pancreatic duct during the pancreaticojejunos- Gagner and Pomp reported the first laparoscopic
tomy creation. The duct-to-mucosa anastomosis is created with a Whipple procedure in 1994. 20 However, because of the
4-0 Vicryl suture on an RB1 needle. The pancreas parenchyma technical difficulty, not many laparoscopic Whipple
and pancreatic duct are seen on the right side of the photograph,
while the jejunum is visualized on the left 10 procedures were performed. Several prospective randomized

World Journal of Laparoscopic Surgery, January-April 2012;5(1):39-45 43