ASO Author Reflections: Advancing the Frontiers of Robotic Pancreaticoduodenectomy: Where are We Headed?

Excerpt

Traditionally, pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been riddled with increased blood loss, especially during the separation of the pancreatic head from the superior mesenteric artery (SMA) stage, which leads to a dim surgical field jeopardizing the R0 resection rate. The ‘SMA-first approach’ was borne out of the need to overcome this issue and aims to achieve the following three goals: (1) early assessment of the SMA before performing the irreversible steps; (2) systematic clearance of mesopancreatic tissue around the SMA; and (3) minimize operative blood loss and improve R0 resection.^1,2 As a further extension to the SMA-first approach, ‘Triangle operation’ was introduced to improve the radicality of surgery by complete clearance of the tumor and associated lymphatic/perineural extension along the SMA and coeliac trunk.³ Although these advancements have been tried and tested in open PD, they are yet to make significant inroads in robotic PD, which in itself is a challenging procedure. …