Left-Sided Uncinate-First Approach as a Technical Adjunct in Robotic Pancreatoduodenectomy: Video-Based Technical Insights in Challenging Anatomy.
Francesca Marcucci, Alessia Fassari, Alexandru Amariutei et al.
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From the abstract
Uncinate process dissection and superior mesenteric artery (SMA) control represent critical steps in robotic pancreatoduodenectomy (RPD). However, the conventional right-sided uncinate-first approach may be technically demanding in patients with unfavorable anatomy, such as visceral obesity or bulky tumors.
Reported results
The right-sided approach for a morbidly obese patient demonstrated limited SMA exposure due to increased operative depth and visceral adiposity, requiring substantial traction to identify the correct dissection plane. Conversely, the left-sided approach enabled early vascular control through creation of a mesenteric window, providing direct access to the SMA and facilitating a controlled medial-to-lateral uncinate…
Authors' conclusions
The left-sided approach represents a feasible technical adjunct in robotic pancreatoduodenectomy. It may enhance SMA exposure and facilitate safer uncinate dissection in selected patients with challenging anatomy, particularly in obesity or bulky tumors. This strategy should be considered within the armamentarium of advanced robotic hepatopancreatobiliary surgery.