{"id":19823,"date":"2026-11-02T16:43:00","date_gmt":"2026-11-02T16:43:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/es\/?p=19823"},"modified":"2026-10-26T00:43:46","modified_gmt":"2026-10-26T00:43:46","slug":"pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/es\/casosclinicos\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\/","title":{"rendered":"Pancreatectom\u00eda Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperatoria en IPMN de Ducto Principal"},"content":{"rendered":"\n<p class=\"has-pale-ocean-gradient-background has-background wp-block-paragraph\"><strong>Autores:<\/strong> Gabrieli M. Oissa, William M.V. Costa, Gustavo F. Araruna, Sebastian N. Geiger, Jaime A. P. Kruger.<\/p>\n\n\n\n<h2 id=\"h-introduccion\" class=\"wp-block-heading\"><br><strong>Introducci\u00f3n<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La neoplasia papilar mucinosa intraductal (IPMN) de ducto principal presenta un riesgo significativo de malignizaci\u00f3n, exigiendo resecci\u00f3n quir\u00fargica en presencia de estigmas de alto riesgo.<br><br>Para lesiones restringidas al segmento medio del p\u00e1ncreas, la pancreatectom\u00eda central surge como una alternativa ahorradora de par\u00e9nquima asociando preservaci\u00f3n funcional y control oncol\u00f3gico. Sin embargo, el gran desaf\u00edo de esta t\u00e9cnica es el riesgo de multifocalidad y el subdimensionamiento de la extensi\u00f3n de la lesi\u00f3n por los ex\u00e1menes de imagen convencionales. En este escenario, la pancreatoscopia intraoperatoria se torna una herramienta valiosa, permitiendo la evaluaci\u00f3n visual directa de la mucosa ductal y de los m\u00e1rgenes de resecci\u00f3n.<\/p>\n\n\n\n<h2 id=\"h-relato-del-caso\" class=\"wp-block-heading\"><br><strong>Relato del Caso<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Paciente femenina, 45 a\u00f1os, con cuadro de dolor epig\u00e1strico intermitente. La investigaci\u00f3n por tomograf\u00eda computarizada contrastada evidenci\u00f3 dilataci\u00f3n difusa del ducto pancre\u00e1tico principal, inici\u00e1ndose pr\u00f3ximo a la uni\u00f3n pancreatobiliar y extendi\u00e9ndose a la porci\u00f3n central. Los marcadores tumorales (CEA y CA 19-9) se encontraban dentro de la normalidad. Ante el deseo de preservaci\u00f3n funcional y la localizaci\u00f3n centrada en la porci\u00f3n media del p\u00e1ncreas, se opt\u00f3 por el abordaje quir\u00fargico m\u00ednimamente invasivo.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fue realizada una pancreatectom\u00eda central rob\u00f3tica (plataforma da Vinci) asociada a linfadenectom\u00eda regional.<\/p>\n\n\n\n<div style=\"position:relative;padding-top:56.25%;\"><iframe id=\"panda-0957760a-002e-490b-9904-e4697b2271ee\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=0957760a-002e-490b-9904-e4697b2271ee\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"has-text-align-left wp-block-paragraph\"><br>Tras el pasaje de los trocares laparosc\u00f3picos, fue introducido el duodenoscopio por v\u00eda oral hasta la segunda porci\u00f3n duodenal, seguido de la canulaci\u00f3n del ducto pancre\u00e1tico principal (DPP) con pasaje de la gu\u00eda y confirmaci\u00f3n del posicionamiento de la gu\u00eda a trav\u00e9s del ultrasonido laparosc\u00f3pico. En seguida, fue realizada la papilotom\u00eda t\u00e1ctica seguida de la introducci\u00f3n del pancreatoscopio. En la topograf\u00eda del cuerpo pancre\u00e1tico fueron identificadas lesiones intraductales tipo \u201chuevos de pez\u201d; la transici\u00f3n para la mucosa normal puede ser identificada n\u00edtidamente, caracterizada por el desaparecimiento de las irregularidades y retorno al aspecto liso y brillante habitual del ducto.<\/p>\n\n\n\n<p class=\"has-text-align-left wp-block-paragraph\"><br>La realizaci\u00f3n intraoperatoria del examen permiti\u00f3 al equipo quir\u00fargico demarcar los m\u00e1rgenes de la lesi\u00f3n en con precisi\u00f3n, ahorrando de esta forma las porciones cef\u00e1lica y caudal. Los m\u00e1rgenes quir\u00fargicos fueron sometidos a estudio an\u00e1tomo-patol\u00f3gico intraoperatorio por congelaci\u00f3n, confirm\u00f3 la ausencia de atipias celulares o neoplasia de alto grado (m\u00e1rgenes libres). La reconstrucci\u00f3n fue realizada por medio de una pancreatoyeyunostom\u00eda en Y de Roux en el remanente pancre\u00e1tico distal.<\/p>\n\n\n\n<h2 id=\"h-discusion\" class=\"wp-block-heading\"><br><strong>Discusi\u00f3n<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La elecci\u00f3n de la pancreatectom\u00eda central en el IPMN de ducto principal exige extrema cautela debido a la naturaleza difusa o multifocal de la enfermedad. Estudios actuales demuestran que la pancreatoscopia intraoperatoria detecta lesiones adicionales en 20-40% de los casos, altera el plan quir\u00fargico en aproximadamente 30-37% de los pacientes, llevando a resecciones extendidas o procedimientos ahorradores de par\u00e9nquima.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Adem\u00e1s, cuando combinada con an\u00e1lisis de congelaci\u00f3n, alcanza 86% de sensibilidad y 92% de especificidad para detecci\u00f3n de tejido patol\u00f3gico en el p\u00e1ncreas remanente.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a><\/a> Sin embargo, a pesar de los resultados prometedores presenta algunas limitaciones como disponibilidad restringida y curva de aprendizaje, heterogeneidad de t\u00e9cnicas entre los grandes centros y falta de estudios prospectivos robustos evaluando impacto en recurrencias y sobrevida.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En el caso relatado, la pancreatoscopia fue decisiva para la indicaci\u00f3n de la pancreatectom\u00eda central. Al mapear endosc\u00f3picamente los l\u00edmites de la lesi\u00f3n, comprobando la ausencia de lesiones en la porci\u00f3n cef\u00e1lica a pesar de la presencia de dilataci\u00f3n, y demostrando transici\u00f3n clara para superficie normal antes de la transici\u00f3n cuerpo-caudal. As\u00ed, fue posible evitar la conversi\u00f3n para una pancreatectom\u00eda subtotal o total, preservando la calidad de vida a largo plazo de la paciente joven.<\/p>\n\n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\"><br><strong>Conclusi\u00f3n<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La pancreatectom\u00eda central rob\u00f3tica asociada a la pancreatoscopia intraoperatoria es una estrategia viable en paciente seleccionada con IPMN de ducto principal localizado en la porci\u00f3n media del p\u00e1ncreas, permitiendo preservaci\u00f3n parenquimatosa, evaluaci\u00f3n directa de los m\u00e1rgenes ductales y toma de decisi\u00f3n intraoperatoria m\u00e1s precisa.<\/p>\n\n\n\n<h2 id=\"h-referencias\" class=\"wp-block-heading\"><br><strong>Referencias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>The Role of Intraoperative Pancreatoscopy in the Surgical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Systematic Scoping Review. Surgical Endoscopy. 2023. Ciprani D, Frampton A, Amar H, et al.<\/li>\n\n\n\n<li>Role of Pancreatoscopy in the Management of Suspected and Confirmed Intraductal Papillary Mucinous Neoplasm of the Pancreas. World Journal of Gastroenterology. 2026. Abusharar M, Barritt C, Mavroeidis VK, Aroori S.Recent<\/li>\n\n\n\n<li>The Role of Intraoperative Pancreatoscopy in the Surgical Management of Intraductal Papillary Mucinous Neoplasms: A Scoping Review. Pancreas. 2024. Grewal M, Habib JR, Paluszek O, et al.<\/li>\n\n\n\n<li>Intraoperative Pancreatoscopy Can Improve the Detection of Skip Lesions During Surgery for Intraductal Papillary Mucinous Neoplasia: A Pilot Study. Pancreatology : Official Journal of the International Association of Pancreatology &#8230;. 2023. Arnelo U, Valente R, Scandavini CM, et al.<\/li>\n<\/ol>\n\n\n\n<h2 id=\"h-como-citar-este-articulo\" class=\"wp-block-heading\"><strong>Como citar este articulo<\/strong><br><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background wp-block-paragraph\">Costa WMV, Oissa GM, Araruna GF, Geiger SN, Kruger JAP, Penaloza CSQ. Pancreatectomia Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperat\u00f3ria em IPMN de Ducto Principal. Endoscopia Terapeutica 2026, Vol II. Disponible en: <a href=\"https:\/\/endoscopiaterapeutica.net\/es\/?p=19823\" target=\"_blank\" rel=\"noopener\">https:\/\/endoscopiaterapeutica.net\/es\/casosclinicos\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Autores: Gabrieli M. Oissa, William M.V. Costa, Gustavo F. Araruna, Sebastian N. Geiger, Jaime&hellip;<\/p>\n","protected":false},"author":6158,"featured_media":19824,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[751],"tipo":[155],"volume":[147],"class_list":["post-19823","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-751","tipo-cpre","volume-volumen-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v28.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Pancreatectom\u00eda Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperatoria en IPMN de Ducto Principal &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/es\/casosclinicos\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pancreatectom\u00eda Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperatoria en IPMN de Ducto Principal\" \/>\n<meta property=\"og:description\" content=\"Autores: Gabrieli M. 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Introducci\u00f3n La neoplasia papilar mucinosa\" \/>\n<meta property=\"og:url\" content=\"https:\/\/endoscopiaterapeutica.net\/es\/casosclinicos\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\/\" \/>\n<meta property=\"og:site_name\" content=\"Endoscopia Terapeutica\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endoscopiaterapeuticaes\" \/>\n<meta property=\"article:published_time\" content=\"2026-11-02T16:43:00+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/endoscopiaterapeutica.net\/es\/wp-content\/uploads\/2026\/10\/Capa-Pancreatectomia-1.jpeg?v=1792859814\" \/>\n\t<meta property=\"og:image:width\" content=\"1366\" \/>\n\t<meta property=\"og:image:height\" content=\"716\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Gabrieli Melissa Oissa\u00a0e\u00a0Cesar Saul Quevedo Penaloza\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Gabrieli Melissa Oissa\u00a0e\u00a0Cesar Saul Quevedo Penaloza\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/\"},\"author\":{\"name\":\"Gabrieli Melissa Oissa\u00a0e\u00a0Cesar Saul Quevedo Penaloza\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/#\\\/schema\\\/person\\\/c665f5a061efba04e6c2a30707f7df88\"},\"headline\":\"Pancreatectom\u00eda Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperatoria en IPMN de Ducto Principal\",\"datePublished\":\"2026-11-02T16:43:00+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/\"},\"wordCount\":899,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/wp-content\\\/uploads\\\/2026\\\/10\\\/Capa-Pancreatectomia-1.jpeg?v=1792859814\",\"articleSection\":[\"Casos Cl\u00ednicos\"],\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/\",\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/es\\\/casosclinicos\\\/pancreatectomia-central-robotica-guiada-por-pancreatoscopia-intraoperatoria-en-ipmn-de-ducto-principal\\\/\",\"name\":\"Pancreatectom\u00eda Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperatoria en IPMN de Ducto Principal &#8226; 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