Anusak Yiengpruksawan

Technique for laparobotic distal pancreatectomy with preservation of spleen

Minimally invasive surgery for pancreas has advanced at a steady pace in recent years. Although proximal pancreatic resection is still a formidable task, distal resection has become routine with a laparoscopic approach. The recent introduction of the Da Vinci Robotic Surgical System has helped to make this complex procedure much more feasible, efficient, and safe. In this paper, we describe our technique for robot-assisted distal pancreatectomy with splenic preservation, which can be broken down into five steps in a medial-to-lateral progression. Preservation of splenic vessels is routine, although in certain instances a Warshaw’s technique is employed. The advantages of the robotic approach are described.

Successful treatment of esophageal metastasis from hepatocellular carcinoma using the da Vinci robotic surgical system.

A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma (HCC) presented with progressive dysphagia. He had undergone liver transplantation for HCC three and a half years prevously. At presentation, his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus, causing a luminal stricture. We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system. Recovery was uneventful and he was been doing well 2 mo after surgery. α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively. During the follow-up period, he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.

Fully robotic total pancreatectomy: technical aspects and outcomes

Robotic total pancreatectomy (RTP) is a novel surgical approach currently performed by a select group of skilled surgeons. As robotic approaches to pancreatic surgery increase worldwide, rates of RTP are expected to increase. However, the standard technique is still evolving and several technical problems still require evaluation. Here, we describe our approach in a stepwise fashion and discuss solutions to overcome technical difficulties.

Annular pancreas in an adult managed by laparobotic surgery: a case report

Annular pancreas in an adult is an uncommon and infrequently reported anomaly which is characterized by the presence of ectopic pancreatic tissue surrounding the descending part of the duodenum. It is one of the few congenital anomalies of the gastrointestinal tract, which can manifest with symptoms late in life (Ravitch and Woods in Ann Surg 132:1116–1127, 1950). In adults, the factors initiating symptoms are recurrent pancreatitis, duodenal stenosis at the site of the annulus, or duodenal or gastric ulceration (Morrell and Keynes in Br J Surg 57:814–816, 1970). Operative management of these cases involves bypassing the obstructed duodenum. Duodenoduodenostomy is routinely performed in neonates and children. We report a case of annular pancreas in a 55-year-old male that was successfully treated with robotic duodenoduodenostomy.