title: Robotic and laparoscopic pancreaticoduodenectomy: a hybrid approach.
abstract: OBJECTIVE
  Minimally invasive surgery is beneficial for complex operations; robotics may improve performance in these procedures; however, robotic pancreaticoduodenectomy (PD) has been plagued by long operative times. We describe a small series (n = 5) of patients who underwent a hybrid PD for treatment of obstructive jaundice and pancreatic mass.
  
  
  METHODS
  After diagnostic laparoscopy, the gallbladder was retracted cephalad and the porta hepatis was dissected. The lesser sac was opened to expose the superior mesenteric vein below the pancreas. Once the vein was cleared, the bile duct, stomach, pancreas, and jejunum were transected. After the uncinate process was cleared, the specimen was removed. The da Vinci S Surgical Robotic System was docked to perform a mucosa-to-mucosa pancreaticojejunostomy and an end-to-side choledochojejunostomy. A stapled gastrojejunostomy and drain placement completed the operation.
  
  
  RESULTS
  Five patients underwent hybrid PD between May 2006 and June 2007. All patients had a history of pancreatitis and presented with obstructive jaundice and a pancreatic mass. The operations were completed with 5 ports. The mean operative time was 7 hours. The mean hospital stay was 9.6 days. At 6 months after the operation, all patients were disease-free.
  
  
  CONCLUSIONS
  Complex procedures such as PD can be accomplished with minimally invasive surgical techniques using robotic instrumentation.
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University Medical Center, Columbus, OH 43210-1228, USA. raaja.narula@osumc.edu
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Narula
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome