Overview

This protocol details a robotic partial duodenal resection with primary side-to-side duodeno-jejunal reconstruction performed on a patient with a 5 cm duodenal stenosis. The procedure is demonstrated step-by-step, highlighting the surgical techniques and postoperative outcomes.

Key Study Components

Area of Science

Surgery
Robotic-assisted procedures
Gastroenterology

Background

The patient was a 75-year-old female with dysphagia, pain, and malnutrition.
She had undergone an endoscopic mucosal resection for a duodenal polyp.
Preoperative imaging was conducted to assess the duodenal stenosis.
Diagnostic esophagogastroduodenoscopy revealed a large fibrotic stenosis.

Purpose of Study

To demonstrate the feasibility and safety of robotic-assisted duodenal resection.
To provide a detailed surgical protocol for similar cases.
To evaluate postoperative recovery and outcomes.

Methods Used

Robot-assisted surgery with specific trocar placements.
Creation of pneumoperitoneum and sterile exposition.
Dissection and mobilization of the duodenum and surrounding structures.
Side-to-side duodeno-jejunal anastomosis using an end stapler.

Main Results

The procedure was completed without complications.
The patient was discharged after a total hospital stay of four days.
Pathological assessment confirmed the removal of the adenoma with focal high-grade dysplasia.
Robotic approach proved to be safe and effective in experienced hands.

Conclusions

Robot-assisted duodenal resection is a viable option for treating duodenal stenosis.
The primary side-to-side anastomosis is an effective alternative to traditional methods.
Further studies may help establish long-term outcomes and benefits.

Frequently Asked Questions

What are the benefits of robotic-assisted surgery?

Robotic-assisted surgery offers enhanced precision, reduced recovery time, and minimized postoperative pain.

How is the patient positioned for the surgery?

The patient is placed in a French position with specific arm placements to facilitate access.

What imaging techniques were used preoperatively?

A computed tomography scan was used to assess the localization and extent of the duodenal stenosis.

What was the postoperative recovery like for the patient?

The patient had an uneventful recovery, starting a soft diet on postoperative day one.

What type of anastomosis was performed?

A primary side-to-side duodeno-jejunal anastomosis was performed using an end stapler.

What were the findings of the pathological assessment?

The assessment revealed a radically removed adenoma with focal high-grade dysplasia.

Institution - University Hospital of Heraklion Crete

Articles Published in JoVE