Artery first approach in robotic pancreatoduodenectomy: right-sided uncinate first technique

Abstract

Several advances have been made since the first days of pancreatic surgery and the Whipple-Kausch procedure: the artery-first approach and TRIANGLE resection for pancreatic cancer of the head have been reported in different variations for open surgery to achieve a complete R0 resection. Since this is one of the main factors for oncologic outcome, it is essential to transfer these techniques to the newest iteration of surgical evolution: robotic pancreatoduodenectomy has shown its comparability to the open approach in the last few years. In this paper, we describe our technique of robotic uncinate-first approach for superior mesenteric artery dissection and provide short-term outcomes from a small patient series. The robotic right-sided uncinate-first approach is feasible and allows safe transfer of oncologic vascular dissection techniques to the minimally invasive setting.