Robotic Pancreatico jejunostomy after Whipple's resection

Description

The pancreatico enteric reconstruction is considered as the Achilles heel of the Whipple’s operation. Many techniques have been described for the pancreatic anastomosis, however there is no significant difference in the pancreatic fistula rates among the different techniques. With the wristed articulation of instruments, a high-quality 3-dimensional vision, and elimination of surgeon tremor, the robotic approach facilitates more delicate and complex procedures, such as Whipple’s operation. Studies comparing the open and robotic pancreatico duodenectomies, showed no significant difference between the two approaches, specifically in terms of pancreatic fistula.
In our practice, we perform a duct to mucosa pancreatico jejunostomy with a stent in the pancreatic duct in the presence of a dilated duct with hard pancreas, whereas in the presence of a soft gland with undilated duct we perform a gland to mucosa pancreatico jejunostomy.
In this video we demonstrate both the techniques of pancreatico jejunostomy we practice.
We do the duct to mucosa technique of pancreatico jejunostomy in 2 layers – the inner layer between the pancreatic duct and jejunal mucosa, while the outer layer between the serosa of jejunum to the pancreatic capsule.
In gland to mucosa technique, we take a single layer of interrupted sutures between the pancreatic parenchyma and the jejunal wall.
It has been proven that the outcomes of the pancreatic anastomosis depends on the surgeon’s familiarity and meticulous execution of the chosen technique, but not on the choice of variant used.
Thus standardization of one’s technique is very important.