title: Robotic resection of intraductal neoplasm of the pancreas.
abstract: BACKGROUND
  Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional open surgery. Computer-assisted surgical devices have recently been approved for general surgical use.
  
  
  OBJECTIVE
  The aim of this study was to report the first known case of pancreatic resection with the use of a computer-assisted, or robotic, surgical device in Latin America.
  
  
  METHODS
  A 37-year-old female with a previous history of radical mastectomy for bilateral breast cancer due to a BRCA2 mutation presented with an acute pancreatitis episode. Radiologic investigation disclosed an intraductal pancreatic neoplasm located in the neck of the pancreas with atrophy of the body and tail. The main pancreatic duct was enlarged. The surgical decision was to perform a laparoscopic subtotal pancreatectomy, using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). Five trocars were used. Pancreatic transection was achieved with vascular endoscopic stapler. The surgical specimen was removed without an additional incision.
  
  
  RESULTS
  Operative time was 240 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4.
  
  
  CONCLUSIONS
  The subtotal laparoscopic pancreatic resection can safely be performed. The da Vinci robotic system allowed for technical refinements of laparoscopic pancreatic resection. Robotic assistance improved the dissection and control of major blood vessels due to three-dimensional visualization of the operative field and instruments with wrist-type end-effectors.
authors.affiliation: Research and Robotic Training Unit-IEP, Hospital Sírio Libanês, São Paulo, Brazil. dctwong@gmail.com
authors.forename: Marcel A C
authors.initials: MA
authors.lastname: Machado
authors.forename: Fábio F
authors.initials: FF
authors.lastname: Makdissi
authors.forename: Rodrigo C
authors.initials: RC
authors.lastname: Surjan
authors.forename: Ricardo Z
authors.initials: RZ
authors.lastname: Abdalla
mesh_terms: D000328:Adult; D001938:Brazil; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010180:Pancreatectomy / Q000295:instrumentation*; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*