Vascular control for difficult uncinate process dissection in robotic pancreatoduodenectomy.

Since its first report in 2003, interest in robotic pancreaticoduodenectomy (RPD) has grown by pancreatic surgeons because of three-dimensional (3D) vision, wristed instruments, and improved ergonomics. In the video, we show vascular control techniques to facilitate dissection of the uncinate process, especially useful when venous vascular infiltration is suspected. This maneuver provides crucial exposure, enabling safe, high-quality oncologic dissection. A 72-year-old man presented with obstructive jaundice of one month´s evolution. Imaging and histological studies demonstrated it to be likely a neoplastic process in the head of the pancreas. RPD was performed with intraoperative vascular control. The final histopathology report showed a moderately differentiated adenocarcinoma (pT2, pN1), with all resection margins free. The external retraction and vascular control techniques described in this video are helpful to mitigate limitations of the current robotic surgery platform and can improve the safety and quality of RPD.