Robotic portomesenteric vein reconstruction using self-fashioned bovine pericardial grafts during Da Vinci-assisted pancreatectomy: a case series with video demonstration

Background: In pancreatic cancer surgery, portomesenteric vein involvement can limit resectability and local tumor control, adversely affecting prognosis. While vascular reconstruction with bovine pericardium is established in open procedures, its feasibility in robot-assisted surgery remains underreported. This study evaluates the technical feasibility of portomesenteric venous reconstruction using bovine pericardium in robotic pancreatic resections ([ Fig. 1 ] [ 2 ] [ 3 ]). Fig. 1 Fig. 2 Fig. 3 Methods: We retrospectively analyzed patients who underwent portomesenteric vein reconstruction with bovine pericardial patches or self-fashioned tube grafts during robotic pancreatic resections at a certified pancreatic center between July 2024 and December 2025. Feasibility and technical success were assessed based on intraoperative outcomes, postoperative complications, and graft patency. Patency was evaluated on contrast-enhanced computed tomography (CT) performed during routine oncological follow-up or when clinically indicated. Results: Ten patients underwent robotic pancreatic resection (4 pancreaticoduodenectomies, 6 total pancreatectomies with splenectomy), with portal vein reconstruction in all (10/10) and superior mesenteric vein reconstruction in 5/10. Four patches (4/10) and 6 (6/10) tube grafts, including one T-shaped graft with splenic vein implantation were used. Two patients also underwent arterial reconstruction or transposition. All grafts were patent on latest follow-up CT (19–364 days, median 52). Four patients experienced serious complications (Clavien-Dindo II:1, IIIb:3, V:1). Delayed gastric emptying (DGE) occurred in 4/10 and postoperative pancreatic fistula (POPF) in 1/10; all resolved without intervention. Conclusion: Robotic portomesenteric vein reconstruction using bovine pericardial grafts is technically feasible and appears safe in the short term during pancreatectomy. The Da Vinci system enabled precise vascular control and suturing in a confined operative field. Bovine pericardium proved to be a viable graft material with no intraoperative complications or early graft failure. These preliminary results support the use of robotic techniques in complex vascular pancreatic surgery, but long-term outcomes require further evaluation in larger studies. The manuscript has been accepted for publication in Surgical Endoscopy on April 6, 2026. Informationen zum Einsatz von KI : Die Erstellung des Abstracts wurde durch den Einsatz von ChatGPT zur Unterstützung beim Schreiben sowie durch Canvas AI zur Erstellung und Bearbeitung von Bild- und Videomaterial begleitet. Publication History Article published online: 27 August 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany