A 13 year old girl was admitted for multiple bouts of pancreatitis. Work up including an MRCP revealed a tortuous and severely dilated pancreatic duct. Non-operative management including ERCP with sphincterotomy failed to improve her symptoms and her bouts of pancreatitis continued to require multiple hospital admissions. The decision for a Roux-En-Y lateral pancreaticojejunostomy (Puestow) was made and she was underwent this procedure using robotic surgery.

The 3 arm standard Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA) was used for the procedure. The operation was performed through 3 robotic ports including one 12 mm camera port at the umbilicus and two 5 mm instrument ports. A 12 mm accessory port for dividing and stapling bowel was placed in the right lower quadrant and a 5th accessory port (5 mm) was placed in the lower abdomen for retraction.

The entire procedure was performed intracorporeally. The patient did well and there were no complications. She was on a clear liquid diet by post-operative day 4. Her diet was advanced slowly to a low-fat diet. A Jackson-Pratt drained placed intraoperatively was removed on post-operative day 6. She went home on post-operative day 8.

The complex details of performing a minimally invasive Puestow can be accomplished safely and effectively using robotic surgery. The advantages of robotic surgery may allow this procedure to be performed using minimally invasive techniques more frequently in the future.