Robot-Assisted Trans-Gastric Drainage and Debridment of Walled-off Pancreatic Necrosis using the Robotic EndoWrist® Stapler for the Da Vinci Xi®

Luca Morelli, MD, FACS; Simone Guadagni, MD; Niccolò Furbetta, MD; Matteo Bianchini, MD; Matteo Palmeri, MD; Desirée Gianardi, MD; Gregorio Di Franco, MD; Martina Picchi, MD; Franco Mosca, MD, FACS; Giulio Di Candio, MD

Product Details
Product ID: ACS-5635
Year Produced: 2018
Length: 8 min.


Walled-off pancreatic necrosis (WOPN) represents a late complication of severe acute pancreatitis, with a high mortality rate. Its management depends on the patient's symptoms and WOPN location. The da Vinci surgical systems have been developed to allow an easier mini-invasive surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using da Vinci Xi platform. Methods: A 63-years old man with acute necrotizing pancreatitis was referred to our center. The patient developed a massive fluid collection causing gastrointestinal obstruction. The CT-scan 6 weeks after the acute episode confirmed the presence of a walled-off pancreatic necrosis compressing the stomach and the first duodenal portion. The patient was surgically treated using the da Vinci Xi platform. Results: Surgery was successfully completed in 130 min. An intraoperative US-guided anterior ideal gastrotomy was first performed. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was performed with the new EndoWrist stapler. Necrosectomy and toilette were performed through the anastomosis. Finally, the anterior gastrotomy was closed with triple layer 3-0 V-Lock running suture and cholecystectomy was done. No conversion or intra-operative complications occurred and the postoperative course was uneventful. A post-operative TC scan showed the collapse of the fluid collection.