LAPAROSCOPIC DISTAL PANCREATECTOMY BY RADICAL ANTEGRADE MODULAR PANCREATOSPLENECTOMY (RAMPS)

We present the case of a 67-year-old woman who had two IPMN in the pancreas body (4 and 2 cm) and underwent robotic distal pancreatectomy with spleen preservation. The video's goals are twofold: to demonstrate that, even in the absence of tactile sensation, haptic adaptations combined with a tridimensional view and articulated forceps favor spleen preservation due to possible vessel dissections. Nonetheless, the main meaningful goal is to approach the vessels safely with upfront vascular control and optimize the field exposition for occasional sutures in the event of inadvertent bleeding. The patient had no complications, and the pathology confirmed the presence of IPMNs with free margins.

The iatrogenic cholecystoduodenal fistula is an unusual biliary problem that is best managed by a collaboration of surgeons and gastroenterologists. We present a case report that describes the successful interdisciplinary management of the fistula. From a technical standpoint, we highlight the dynamic use of ICG to identify biliary anatomy and assess for bile leaks, as well as, the consideration of thoughtful dissection through quality tissue planes.

This video demonstrates a patient who presented with a large pancreatic tail mass biopsy proven to be pancreatic adenocarcinoma (PDAC) and treated with a 4 trocar laparoscopic distal pancreatectomy. Due to the large size and malignant nature of the lesion, Radical Antegrade Modular Pancreatosplenectomy (RAMPS) technique was used to ensure a complete resection with radial margin clearance. In a posterior RAMPS, the left adrenal gland and retroperitoneal tissue from the left renal vein to the diaphragm is cleared. Medially, a lymphadenectomy to the left of the celiac and superior mesenteric artery is performed.