Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1461-1466
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1461
Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi: A case report
Luca Morelli, Niccolò Furbetta, Desirée Gianardi, Matteo Palmeri, Gregorio Di Franco, Matteo Bianchini, Gianni Stefanini, Simone Guadagni, Giulio Di Candio
Luca Morelli, Niccolò Furbetta, Desirée Gianardi, Matteo Palmeri, Gregorio Di Franco, Matteo Bianchini, Gianni Stefanini, Simone Guadagni, Giulio Di Candio, General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
Luca Morelli, EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa 56124, Italy
Author contributions: Morelli L, Furbetta N, Gianardi D, Palmeri M, Di Franco G, Bianchini M, Stefanini G, Guadagni S and Di Candio G conceived and design the study; Furbetta N, Gianardi D, Palmeri M, Di Franco G, Stefanini G, Bianchini M and Guadagni S acquired data; Morelli L and Di Candio G analyzed and interpreted the data; Morelli L, Furbetta N, Gianardi D, Palmeri M, Di Franco G, Bianchini M, Stefanini G and Guadagni S drafted the manuscript; Morelli L and Di Candio G critically revised the manuscript; all authors have read and approved the final version to be published.
Informed consent statement: The patient and his family provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Luca Morelli, FACS, MD, Associate Professor, General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa 56124, Italy. luca.morelli@unipi.it
Telephone: +39-50-995470 Fax: +39-50-996985
Received: January 26, 2019
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.

Keywords: Case report, da Vinci Xi, EndoWrist stapler, Walled-off pancreatic necrosis, TilePro, Minimally-invasive surgery

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.