Emergency robotic Roux-en-Y cystojejunostomy by Da Vinci Xi® for an infected pancreatic pseudocyst

Résumé fourni par la source

Pancreatic pseudocysts are fluid collections without proper wall containing pancreatic juice or liquefied necrosis, sitting within or outside the pancreas. Pancreatic pseudocysts are a common complication of chronic pancreatitis. Complications of pseudocysts include compression of neighboring organs, infection, bleeding and rupture. The surgical management of pancreatic pseudocysts can be established by various techniques. New possibilities for internal drainage are now possible with the growing popularity of minimaly invasive surgery and improvements in surgical techniques. We present a robotic-assisted surgical technique that promotes the emergency drainage of a pancreatic pseudocyst in a patient with a significant past medical history and a large hiatal hernia. The patient with a medical history of chronic calcifying pancreatitis, presented with a recent incident of an infected pancreatic pseudocyst measuring 6 × 7 cm transversely, located in the tail of the pancreas. Considering that endoscopic drainage was not possible because of a hiatal hernia with the entirely stomach located in the chest, we decided to perform a minimally invasive robotic-assisted roux-en-Y cystojejunostomy. This procedure was performed using Da Vinci Xi® robotic surgical system and lasted 180 min. Although endoscopic cystogastrostomy is an established approach, robotic-assisted cystojejunostomy is an effective and safe alternative for medical history our patient. Although endoscopic treatment is a proven method for drainage of infected pseudocysts, anatomical particularities make it not suitable. The cystojejunostomy derivation technique reported in this presentation appears to be safe and effective alternative to endoscopic therapy in contraindicated patients.

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