Robotic Whipple Procedure for an Ampullary Intramucosal Carcinoma

1. Introduction

2. Laparoscopic Access, Diagnostic Laparoscopy, and Biopsy of a Liver Nodule

1. Skin Marking
2. Port Placement, Insufflation with Hasson's Technique, and Diagnostic Laparoscopy
3. Biopsy of the Liver Nodule
4. Frozen Section Results

3. Division of Falciform Ligament and Liver Retraction with Transfascial Endoloop Suture

4. Mini-Pfannenstiel Incision

5. Robot Docking

6. Division of Gastrocolic Ligament, Mobilization of Right Colon, and Kocher Maneuver

1. Preparation for GJ Anastomosis
2. Kocher Maneuver

7. Pancreaticoduodenectomy and Lymphadenectomy

1. Inframesocolic Dissection of Duodenojejunal Flexure
2. Division of Proximal Jejunum
3. Further Retrograde Dissection of Duodenum
4. Division of Stomach Proximal to Pylorus
5. Excision Biopsy of Station 8 Lymph Node
6. Ligation and Division of Gastroduodenal Artery
7. Cholecystectomy
8. Dissection of Extrahepatic Bile Ducts Within Hepatoduodenal Ligament; Ligation and Division of Common Hepatic Duct
9. Creation of Retropancreatic Tunnel and Division of Pancreas at its Neck
10. Conclusion of Pancreaticoduodenal Resection: Mobilization and Excision of Duodenum and Head of Pancreas
11. Retrieval of Specimen

8. Pancreaticojejunostomy

9. Hepaticojejunostomy

10. Gastrojejunostomy

11. Robot Undocking

12. Laparoscopic Access, TAP Block, Additional Irrigation and Suction, and Application of Fibrin Sealant

13. Desufflation and Closure

14. Post-op Remarks