How Do We Form Pancreatogastroanastomosis During Robot-Assisted and Laparoscopic Whipple Procedure

The proposed method for the formation of pancreatogastroanastomosis in robotic and laparoscopic pancreatoduodenal resections included the imposition of a suture holder on an atraumatic needle with an absorbable thread on the stump of the pancreas. This suture was fixed by the upper and lower edges of the stump. At the same time, a loop was formed, for which a metered thrust was subsequently carried out. Then, opposite the stump of the pancreas, a gastrotomy of the posterior wall of the stomach was performed in the transverse direction. The gastrotomic opening was created up to 1/3 of the incision area of the pancreatic stump. Such a discrepancy in size is necessary to ensure the tightness of the subsequent anastomosis, but this leads to the difficulty of placing the stump of the pancreas in the lumen of the stomach. After that, the proximal semicircle of the gastrotomic opening was fixed to the anterior surface of the pancreas. Then a nasogastric probe with a diameter of 4.5-5.1 mm with a plastic conductor was passed through a gastrotomic hole on the back wall of the stomach into the abdominal cavity. After that, the conductor was pulled up to the nearest hole of the probe. A loop of the seam holder was wound into this hole, fixing it, lowering the conductor back into the probe under visual control. The stump of the pancreas was moderately pulled up by a probe 4-5 cm in the proximal direction, invaginating it into the lumen of the stomach with a thread, which was sewn the proximal semicircle of the gastrotomic opening to the anterior surface of the pancreas, continuing in the opposite direction along the posterior surface of the pancreas. As a result, a circular pancreatogastoanastomosis was obtained with a single-row suture. The retaining loop of the absorbable material was released by removing the plastic conductor from the probe. A patent for the invention was obtained for the proposed PGA method.