Reduced-port robotic pancreaticoduodenectomy with optimized surgical field deployment: early results of single-site plus-two ports method

• DOI: 10.1007/s00464-024-11097-y
• Publication Date: 2024-07-24T18:17:23Z
• Authors: Riki Ninomiya; Masahiko Komagome; Satoru Abe; Shohei Maruta; Shinichi Matsudaira; Noriki Okada; Kazuhiro Mori; Rihito Nagata; Takehiro Chiyoda; Akifumi Kimura; Nobuyuki Takemura; Akira Maki; Yoshifumi Beck; Ching-Lung Hsieh; Cheng-Ming Peng
• Keywords: Port (circuit theory)

Abstract Background The adoption of Robotic Pancreaticoduodenectomy (RPD) is increasing globally. Meanwhile, reduced-port RPD (RPRPD) remains uncommon, requiring robot-specific techniques not possible with laparoscopy. We introduce a unique RPRPD technique optimizing surgical field exposure. Methods Our utilizes single-site plus-two ports technique, facilitated by single-port platform through 5-cm incision. configuration robotic arms (arm1, arm2, arm3, and arm4) were strategically designed for optimal procedural efficiency, the arms2 alongside assistant trocar, mounted on platform, while arms1 arm4 positioned laterally across abdomen. Drainage was established via channels created at arm1 insertion sites. A “gooseneck traction” principally employed instrument to prop up specimen rather than grasp, improving field’s visibility access. Clinical outcomes patients who underwent performed between August 2020 September 2023 single surgeon two centers in Taiwan Japan reviewed. Results Fifty using technique. gooseneck traction enabled goodsurgical deployment allowed unrestricted movement no collisions instruments. median operative time 351 min (250–488 min), including 271 (219–422 min) console three minutes (2–10 docking time. estimated blood loss 80 mL (1–872 mL). All procedures successfully without need conversion open surgery. Postoperative major morbidity (i.e., Clavien-Dindo grade ≥ IIIa) observed 6 (12%) postoperative hospital stay 13 days. Conclusions proves be safe, feasible option, facilitating arm maneuverability. Graphical