Robotic pancreatoduodenectomy for a solid pseudopapillary tumor in a ten-year-old child

Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [1]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open...

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Bibliographic Details
Published in:Surgical oncology 2018-12, Vol.27 (4), p.635-636
Main Authors: Hagendoorn, Jeroen, Nota, Carolijn L.M.A., Borel Rinkes, Inne H.M., Molenaar, I. Quintus
Format: Article
Language:English
Subjects:
Anesthesia
Body weight
Carcinoma, Papillary - pathology
Carcinoma, Papillary - surgery
Child
Children
Feasibility
Feasibility studies
Female
Gastric emptying
Humans
Laparoscopy
Laparoscopy - methods
Minimally invasive surgery
Mucosa
Oncology
Pain
Pancreas
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreatic resection
Pancreaticoduodenectomy
Pancreaticoduodenectomy - methods
Pediatric whipple resection
Placement
Prognosis
Quadrants
Robot arms
Robotic surgery
Robotic Surgical Procedures - methods
Surgery
Telesurgery
Tumors
Video-Assisted Surgery - methods
Whipple resection
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Summary:Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [1]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open surgery [2], it remains to be determined whether the pediatric population may potentially benefit from this minimally invasive procedure. Here we present, for the first time, a video of setup and surgical technique of robotic pancreatoduodenectomy in a child. A 10-year-old girl presented with complaints of fullness and abdominal pain in the upper quadrants. Investigations including a diffusion-weighted, pancreatic MR scan suggested the diagnosis of solid pseudopapillary tumor (Frantz's tumor). The patient was considered for robotic pancreatoduodenectomy. After anesthesia, the patient was placed supine on a split-leg table. Trocar placement was adjusted to accommodate the child's length and body weight, according to pre-operatively calculated positions that would allow for maximum working space and minimize inadvertent collision between the robotic arms. The da Vinci Si surgical robot was positioned in-line towards the surgical target and all four robotic arms were docked, while two additional laparoscopic ports were placed for tableside assistance. After standard pancreatoduodenectomy, a conventional loop reconstruction was performed including an end-to-side pancreaticojejunostomy with duct-to-mucosa technique and stapled side-to-side gastrojejunostomy. We suggest that in this patient group, pylorus preserving pancreatoduodenectomy with end-to-side duodenojejunostomy may be a suitable alternative. Postoperative recovery was complicated by delayed gastric emptying but otherwise unremarkable. Hospital length of stay was 12 days. Final pathology demonstrated a solid pseudopapillary tumor with negative surgical margins. This case illustrates the feasibility of robotic pancreatoduodenectomy in children. Essential elements of this procedure are a well-running robotic pancreatic surgery program as well as careful preoperative port placement planning. •Pediatric pancreatoduodenectomy is feasible, although rarely indicated.•Potentially, minimally invasive pancreatoduodenectomy offers several benefits.•This video demonstrates the feasibility of robotic pancreatoduodenectomy in a child.•Port placement and a well-running robotic pancreatic surgery program are essential.
ISSN:0960-7404
1879-3320
DOI:10.1016/j.suronc.2018.07.013