Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1461
Peer-review started: January 28, 2019
First decision: April 18, 2019
Revised: April 24, 2019
Accepted: May 2, 2019
Article in press: May 3, 2019
Published online: June 26, 2019
Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi.
A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic trans-gastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro™ function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection.
In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
Core tip: Trans-gastric drainage and debridement of the walled-off pancreatic necrosis is a valid surgical treatment in selected cases. The da Vinci Xi robotic platform with its increased flexibility, together with its new technologies, gives advantages in performing this surgical procedure. In particular, the new EndoWrist robotic stapler, noting the suitable thickness of the tissues between the branches, should reduce the risk of bleeding related to the cystogastrostomy. Moreover, it can be articulated with a range of 108° allowing the operator to directly control all the steps of the suture. Finally, the TilePro™ function can superimpose ultrasound imaging on the console screen, alongside the operatory field, giving high degree of precision in defining the best location for the gastrostomy.