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Fig. 27.2 Intraoperative

Laparoscopic Enucleation

Patient Positioning
L. Milone et al.
Fig. 27.3 Patient position for laparoscopic enucleation of small PNETs
Procedure
Fig. 27.4 A laparoscopic
Fig. 27.5 Port placements
Fig. 27.6 Enucleation of a
Fig. 27.7 A pancreatic
L. Milone et al.

Robotic Enucleation

ab
Patient Positioning
Procedure
Fig. 27.8 Position of DaVinci Xi boom relative to patient. (a) Side view. (b) Top view
ab
L. Milone et al.
Fig. 27.9 Ports placement for DaVinci Xi robotic resection. (a) Pancreatic head lesion. (b)
Pitfalls ofMinimally Invasive Procedures

Open Enucleation

a b
Fig. 27.10 Pancreatic lesion located in the uncinate process of the pancreas. (a) Uncinate process

Postoperative Management

Postoperative Outcomes

L. Milone et al.
Acknowledgments Thank Dr. Pecorelli Nicolò (Faculty of Medicine and Surgery of San Raffaele
Financial Disclosures Drs. Mei Zhen Cao, Andrew Gumbs, Romulo Genato, and Luca Milone

References

Chapter 28
Minimally Invasive Central Pancreatectomy
VincentButano, IswantoSucandy, SharonaRoss, andAlexanderRosemurgy

Introduction

A central pancreatectomy (CP) is a relatively uncommon operation in the United States, indicated for benign and low malignant potential pancreatic body tumors [1,
2]. CP either undertaken via “open” or minimally invasive method is proposed and
utilized as an alternative surgical treatment to a distal pancreatectomy to preserve pancreatic parenchyma. The CP has declined in popularity due concerns of increased morbidity specically related to postoperative pancreatic leak and stula relative to non-parenchymal sparing techniques [3]. As imaging technology of computed tomography (CT) and magnetic resonance (MR) scans continue to improve, detec­tion rate of small, mid-body pancreatic lesions increases and becomes a more rele­vant clinical question in daily clinical practice of pancreatic surgery. Additionally, nuclear medicine modality such as Dotatate scan has demonstrated the ability to improve detection of small pancreatic neuroendocrine tumors as well [4, 5]. It stands to reason that as detection of these lesions becomes more common, a central pancreatectomy may have a developing role in the management of these patients.
The advent and rapid adoption of robotic hepatopancreatobiliary surgery in the
US changes the choice of surgical techniques in pancreatic surgery. The increased
V. Butano Digestive Health Institute at AdventHealth, Tampa, FL, USA
I. Sucandy ( Department of Surgery, University of Central Florida, Orlando, FL, USA e-mail: iswanto.sucandy@adventhealth.com
S. Ross · A. Rosemurgy Department of Surgery, University of Central Florida, Orlando, FL, USA
Department of Surgery, Nova Southeastern University, Fort Lauderdale, FL, USA
Switzerland AG 2025 E. P. Ceppa et al. (eds.), The SAGES Manual of Evolving Techniques in Pancreatic Surgery, https://doi.org/10.1007/978-3-031-78409-5_28
*)
471© The Author(s), under exclusive license to Springer Nature