Robotic Isolated Pancreaticojejunostomy After Pancreatoduodenectomy: A Good Choice for Young Patients with Expected Long‑Term Survival

Pancreatoduodenectomy (PD) is the procedure of choice
for resectable tumors located in the head of the pancreas.
Until recently, this procedure was associated with high mor
tality and morbidity. The complications after pancreatoduo
denectomy mainly concern postoperative pancreatic fistula
(POPF), which is the main cause of morbidity and mortal
ity. Among the various techniques to reduce the incidence
of clinically relevant POPF, the use of an isolated jejunal
loop for pancreatojejunostomy was introduced by Machado
in 1976.

We present a video of an 18-year-old woman with a 6
cm solid pseudopapillary neoplasm in the head of the pan
creas. Magnetic resonance imaging (MRI) showed
no dilatation of the bile duct or pancreatic duct. The mul
tidisciplinary team opted for a pylorus-preserving pancrea
toduodenectomy. Given the young age of the patient and the
high risk of pancreatic fistula, we opted for an isolated pan
creatojejunostomy. We proposed a robotic approach
and obtained consent.