title: Robot-assisted subtotal pancreas-preserving duodenectomy.
abstract: BACKGROUND
  Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance.
  
  
  METHODS
  The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy.
  
  
  RESULTS
  The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage.
  
  
  CONCLUSIONS
  The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery.
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, IL 60612, USA. mmasrur@uic.edu
authors.forename: Mario
authors.initials: M
authors.lastname: Masrur
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Paolo
authors.initials: P
authors.lastname: Raimondi
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Ugo
authors.forename: David
authors.initials: D
authors.lastname: Calatayud
authors.forename: Pier C
authors.initials: PC
authors.lastname: Giulianotti
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D012371:Robotics