ASO Author Reflections: Added Value of the Robotic Approach in Posterior Radical Antegrade Modular Pancreatosplenectomy

Excerpt

Since its first description by Strasberg et al. in 2003,¹ radical antegrade modular pancreatosplenectomy (RAMPS) has gained much attention because of its possibility of achieving negative posterior margins during left pancreatectomies for pancreatic cancers (PCs), which could impact long-term outcomes.² In this procedure, the dissection plane does not pass through the anatomical and avascular plane between the pancreatic gland and the perirenal tissue, but goes deeper and includes the renal fat and, occasionally, the adrenal gland (posterior RAMPS). Dissection of the main vascular structures, as in the superior mesenteric artery and left renal veins, are however necessary in these cases, increasing the technical complexity of the procedure and, eventually, postoperative complications. Use of minimally invasive approaches in left pancreatectomies, especially laparoscopic pancreatectomy, is currently the gold standard in resectable cases, leading to similar outcomes as the open approach.³ However, when more challenging cases are performed, as in the case of a posterior RAMPS, the robotic platform can overcome simple laparoscopy thanks to its dexterity and the ability gained during dissection of vascular structures.⁴ …