Management of Intra-Operative Hemorrhage and Safe Venous Resection in Robotic-Assisted Pancreaticoduodenectomy: Techniques to Avoid Open Conversion

Robotic-assistedpancreaticoduodenectomy (RPD) is increasingly utilized for operableperiampullary malignancies with oncologic outcomes compared to the openapproach. Indications can be carefully expanded to select borderline resectabletumors, but bleeding remains a significant threat. Moreover, the need for venousresection and reconstructions increases as more complex cases are selected to undergo RPD. Herein, we present a video compilation of our approach to safevenous resections during RPD, followed by several video examples ofintraoperative hemorrhage highlighting various techniques and tips that theconsole and bedside surgeon can utilize to control bleeding. Conversion to anopen procedure should not be seen as a failure but rather as a safe and soundintraoperative decision made in the patient's best interest. Nonetheless, withexperience and proper technique, many intraoperative hemorrhages and venous resectionscan be managed in a minimally invasive fashion.

Automated summary

Robotic-assisted pancreaticoduodenectomy (RPD) is a commonly used approach for operable periampullary malignancies, with better oncologic outcomes compared to open surgery. Bleeding can be a significant challenge, especially in cases requiring venous resection and reconstruction. This article provides a video compilation demonstrating a safe approach to venous resections during RPD and offers techniques and tips for controlling bleeding.