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Background <p>Pancreaticoduodenectomy (PD) is a complex procedure, and robotic PD (RPD) has been reported to have benefits in reducing postoperative complications. However, the timing and order for dividing arteries and veins remain unstandardized. We developed a novel technique, pancreatic head clockwise devascularization, to minimize intraoperative bleeding in RPD.</p> Methods <p>We retrospectively analyzed 39 patients who underwent RPD between April 2022 and September 2024. The clockwise devascularization technique divides 1) the gastroduodenal artery, 2) the 1st-jejunal vein branches, and 3) the inferior pancreatoduodenal artery + 1st-jejunal artery. Outcomes were compared with the conventional superior mesenteric artery (SMA)-first approach.</p> Results <p>Of the 39 patients, 14 were in the clockwise devascularization group and 25 in the SMA-first group. The clockwise group had a significantly shorter operation time (616 vs. 772&#xa0;min, <i>P</i> &lt; 0.01) and lower blood loss (50 vs. 330&#xa0;ml, <i>P</i> = 0.03). There were no clinically relevant pancreatic fistulas or delayed gastric emptying in either group. The median hospital stay was shorter in the clockwise group (5.5 vs. 8.0&#xa0;days, <i>P</i> &lt; 0.01).</p> Conclusions <p>The pancreatic head clockwise devascularization technique may be an effective technique to systematically devascularize the pancreatic head.</p>

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Pancreatic head clockwise devascularization technique during robotic pancreaticoduodenectomy to minimize intraoperative bleeding

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月28日

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  • Kyoji Ito,
  • Yoshikuni Kawaguchi,
  • Satoru Abe,
  • Yuichiro Mihara,
  • Yujiro Nishioka,
  • Akihiko Ichida,
  • Takeshi Takamoto,
  • Nobuhisa Akamatsu,
  • Kiyoshi Hasegawa

摘要

Background

Pancreaticoduodenectomy (PD) is a complex procedure, and robotic PD (RPD) has been reported to have benefits in reducing postoperative complications. However, the timing and order for dividing arteries and veins remain unstandardized. We developed a novel technique, pancreatic head clockwise devascularization, to minimize intraoperative bleeding in RPD.

Methods

We retrospectively analyzed 39 patients who underwent RPD between April 2022 and September 2024. The clockwise devascularization technique divides 1) the gastroduodenal artery, 2) the 1st-jejunal vein branches, and 3) the inferior pancreatoduodenal artery + 1st-jejunal artery. Outcomes were compared with the conventional superior mesenteric artery (SMA)-first approach.

Results

Of the 39 patients, 14 were in the clockwise devascularization group and 25 in the SMA-first group. The clockwise group had a significantly shorter operation time (616 vs. 772 min, P < 0.01) and lower blood loss (50 vs. 330 ml, P = 0.03). There were no clinically relevant pancreatic fistulas or delayed gastric emptying in either group. The median hospital stay was shorter in the clockwise group (5.5 vs. 8.0 days, P < 0.01).

Conclusions

The pancreatic head clockwise devascularization technique may be an effective technique to systematically devascularize the pancreatic head.