Complete Segmental Parenchymal Vascular Occlusion for Robotic Enucleation of Distal Pancreatic Tumors (with video).

Abstract

Pancreatic enucleation is a parenchyma-sparing procedure for selected benign and low-grade malignant tumors; however, diffuse parenchymal bleeding during dissection often compromises visualization and increases the risk of main pancreatic duct injury, particularly for large, deep, or duct-adjacent lesions. Effective and reproducible blood-flow control strategies for minimally invasive pancreatic enucleation remain limited. We describe a novel technique of complete segmental parenchymal vascular occlusion during robotic enucleation of distal pancreatic tumors. By bilaterally encircling the pancreatic parenchyma adjacent to the lesion using customized occlusion loops, temporary and localized parenchymal devascularization was achieved without clamping major arterial or venous trunks. The technique was applied in selected patients undergoing robotic pancreatic enucleation. Operative details, perioperative outcomes, and postoperative recovery were evaluated. A step-by-step surgical demonstration is provided in an accompanying video. Segmental parenchymal vascular occlusion consistently provided a near-bloodless operative field, markedly improving visualization and precision during tumor enucleation. The technique facilitated safe dissection along the tumor-duct interface and reduced the risk of inadvertent main pancreatic duct injury, even in large, deep, or anatomically challenging lesions. Postoperative outcomes were favorable, with low morbidity and preservation of pancreatic function. No cases of parenchymal ischemic necrosis were observed. Complete segmental parenchymal vascular occlusion is a simple, safe, and effective adjunct for robotic pancreatic enucleation. By enabling localized and reversible parenchymal devascularization without major vessel occlusion, this technique enhances operative safety and expands the feasibility of parenchyma-sparing surgery for distal pancreatic tumors.