Robot-Assisted Laparoscopic Central Pancreatectomy with Pancreaticogastrostomy (Transgastric Approach)

Abstract

Since Guillemin and Bessot firstly reported central pancreatectomy in 1957,9 only a few authors described this technique in the management of pancreatic tumor in the pancreatic neck area. The theoretic benefit of central pancreatectomy is preservation of remnant pancreas parenchyma enough to reduce an incidence of endocrine and exocrine insufficiency, conservation of spleen to maintain immunologic function, and continuity of biliary drainage which is thought to be more physiologic than choledochoenterosotmy after pancreaticoduodenectomy. By reconstruction of pancreaticogastrostomy following central pancreatectomy, conserving continuity of upper gastrointestinal tract can be another advantage of this procedure. Despite of controversy in reconstruction of remnant pancreas (pancreaticojejunosotmy vs. pancreaticogastrosotmy), potential advantages of pancreaticogastrostomy has been advocated.10-13 Recently, Bassi, et. al14 introduced their surgical technique, " open pancreaticogastrostomy after pancreaticoduodenectomy". Even