{"id":21958,"date":"2026-10-06T07:00:00","date_gmt":"2026-10-06T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=21958"},"modified":"2026-10-06T13:58:47","modified_gmt":"2026-10-06T13:58:47","slug":"pancreatoscopia-intraoperatoria-pancreatectomia-central-ipmn","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/pancreatoscopia-intraoperatoria-pancreatectomia-central-ipmn\/","title":{"rendered":"Pancreatectomia Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperat\u00f3ria em IPMN de Ducto Principal"},"content":{"rendered":"\n<p class=\"has-pale-ocean-gradient-background has-background wp-block-paragraph\"><strong>Autores:<\/strong> William Marchelli Vilela Costa, Gabrieli Melissa Oissa , Gustavo Ferreira Araruna, Sebastian Naschold Geiger, Jaime Arthur Pirola Kruger<\/p>\n\n\n\n<h2 id=\"h-introducao\" class=\"wp-block-heading\"><br><strong>Introdu\u00e7\u00e3o<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A neoplasia papilar mucinosa intraductal (IPMN) de ducto principal apresenta um risco significativo de maligniza\u00e7\u00e3o, exigindo ressec\u00e7\u00e3o cir\u00fargica na presen\u00e7a de estigmas de alto risco.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Para les\u00f5es restritas ao segmento m\u00e9dio do p\u00e2ncreas, a pancreatectomia central surge como uma alternativa poupadora de par\u00eanquima, associando preserva\u00e7\u00e3o funcional e controle oncol\u00f3gico. No entanto, o grande desafio dessa t\u00e9cnica \u00e9 o risco de multifocalidade e o subdimensionamento da extens\u00e3o da les\u00e3o pelos exames de imagem convencionais. Nesse cen\u00e1rio, a pancreatoscopia intraoperat\u00f3ria torna-se uma ferramenta valiosa, permitindo a avalia\u00e7\u00e3o visual direta da mucosa ductal e das margens de ressec\u00e7\u00e3o.<\/p>\n\n\n\n<h2 id=\"h-relato-do-caso\" class=\"wp-block-heading\"><br><strong>Relato do Caso<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Paciente feminina, 45 anos, com quadro de dor epig\u00e1strica intermitente. A investiga\u00e7\u00e3o por tomografia computadorizada contrastada evidenciou dilata\u00e7\u00e3o difusa do ducto pancre\u00e1tico principal, iniciando-se pr\u00f3ximo \u00e0 jun\u00e7\u00e3o pancreatobiliar e estendendo-se \u00e0 por\u00e7\u00e3o central. Os marcadores tumorais (CEA e CA 19-9) encontravam-se dentro da normalidade. Desse modo, diante do desejo de preserva\u00e7\u00e3o funcional e da localiza\u00e7\u00e3o centrada na por\u00e7\u00e3o m\u00e9dia do p\u00e2ncreas, optou-se pela abordagem cir\u00fargica minimamente invasiva.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Foi realizada uma pancreatectomia central rob\u00f3tica (plataforma da Vinci) associada \u00e0 linfadenectomia 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\">Ap\u00f3s a passagem dos trocartes laparosc\u00f3picos, foi introduzido o duodenosc\u00f3pio por via oral at\u00e9 a segunda por\u00e7\u00e3o duodenal, seguido da canula\u00e7\u00e3o do ducto pancre\u00e1tico principal (DPP) com passagem do fio guia e confirma\u00e7\u00e3o do posicionamento do fio guia atrav\u00e9s do ultrassom laparosc\u00f3pico. Em seguida, foi realizada a papilotomia t\u00e1tica, seguida da introdu\u00e7\u00e3o do pancreatosc\u00f3pio. Na topografia do corpo pancre\u00e1tico foram identificadas les\u00f5es intraductais do tipo \u201covas de peixe\u201d; a transi\u00e7\u00e3o para a mucosa normal p\u00f4de ser identificada nitidamente, caracterizada pelo desaparecimento das irregularidades e pelo retorno ao aspecto liso e brilhante habitual do ducto.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nesse sentido, a realiza\u00e7\u00e3o da pancreatoscopia intraoperat\u00f3ria permitiu \u00e0 equipe cir\u00fargica demarcar as margens da les\u00e3o com precis\u00e3o, poupando desta forma as por\u00e7\u00f5es cef\u00e1lica e caudal. As margens cir\u00fargicas foram submetidas a estudo anatomopatol\u00f3gico intraoperat\u00f3rio por congela\u00e7\u00e3o, que confirmou a aus\u00eancia de atipias celulares ou displasia de alto grau (margens livres). A reconstru\u00e7\u00e3o foi realizada por meio de uma pancreatojejunostomia em Y de Roux no remanescente pancre\u00e1tico distal.<\/p>\n\n\n\n<h2 id=\"h-discussao\" class=\"wp-block-heading\"><br><strong>Discuss\u00e3o<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A escolha da pancreatectomia central no IPMN de ducto principal exige extrema cautela devido \u00e0 natureza difusa ou multifocal da doen\u00e7a. Estudos atuais demonstram que a pancreatoscopia intraoperat\u00f3ria detecta les\u00f5es adicionais em 20-40% dos casos, altera o plano cir\u00fargico em aproximadamente 30-37% dos pacientes, levando a ressec\u00e7\u00f5es estendidas ou procedimentos poupadores de par\u00eanquima.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Al\u00e9m disso, quando combinada \u00e0 an\u00e1lise por congela\u00e7\u00e3o, atinge 86% de sensibilidade e 92% de especificidade para detec\u00e7\u00e3o de tecido patol\u00f3gico no p\u00e2ncreas remanescente.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No entanto, apesar dos resultados promissores, o m\u00e9todo apresenta algumas limita\u00e7\u00f5es, como disponibilidade restrita, curva de aprendizado, heterogeneidade de t\u00e9cnicas entre os grandes centros e falta de estudos prospectivos robustos que avaliem o impacto em recorr\u00eancias e sobrevida.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No caso relatado, a pancreatoscopia foi decisiva para a indica\u00e7\u00e3o da pancreatectomia central. O mapeamento endosc\u00f3pico dos limites da les\u00e3o comprovou a aus\u00eancia de acometimento da por\u00e7\u00e3o cef\u00e1lica, apesar da dilata\u00e7\u00e3o ductal. Al\u00e9m disso, demonstrou transi\u00e7\u00e3o n\u00edtida para mucosa normal antes da jun\u00e7\u00e3o corpo-caudal. Assim, foi poss\u00edvel evitar a convers\u00e3o para uma pancreatectomia subtotal ou total, preservando a qualidade de vida a longo prazo da paciente jovem.<\/p>\n\n\n\n<h2 id=\"h-conclusao\" class=\"wp-block-heading\"><br><strong>Conclus\u00e3o<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A pancreatectomia central rob\u00f3tica associada \u00e0 pancreatoscopia intraoperat\u00f3ria \u00e9 uma estrat\u00e9gia vi\u00e1vel em paciente selecionada com IPMN de ducto principal localizado na por\u00e7\u00e3o m\u00e9dia do p\u00e2ncreas, permitindo preserva\u00e7\u00e3o parenquimatosa, avalia\u00e7\u00e3o direta das margens ductais e tomada de decis\u00e3o intraoperat\u00f3ria mais precisa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"has-pale-ocean-gradient-background has-background wp-block-paragraph\">Para saber mais sobre o papel da pancreatoscopia no manejo do IPMN, acesse a revis\u00e3o de <a href=\"https:\/\/www.wjgnet.com\/1007-9327\/full\/v32\/i4\/112635.htm\">Abusharar et al. (2026)<\/a>.<\/p>\n\n\n\n<h2 id=\"h-referencias\" class=\"wp-block-heading\"><br><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Abusharar M, Barritt C, Mavroeidis VK, Aroori S. Role of pancreatoscopy in the management of suspected and confirmed intraductal papillary mucinous neoplasm of the pancreas. World J Gastroenterol. 2026;32(4):112635.<\/li>\n\n\n\n<li>Ciprani D, Frampton A, Amar H, Oppong K, Pandanaboyana S, Aroori S. The role of intraoperative pancreatoscopy in the surgical management of intraductal papillary mucinous neoplasms of the pancreas: a systematic scoping review. Surg Endosc. 2023;37(12):9043-51.<\/li>\n\n\n\n<li>Grewal M, Habib JR, Paluszek O, Cohen SM, Wolfgang CL, Javed AA. The role of intraoperative pancreatoscopy in the surgical management of intraductal papillary mucinous neoplasms: a scoping review. Pancreas. 2024;53(3):e280-7.<\/li>\n\n\n\n<li>Arnelo U, Valente R, Scandavini CM, Halimi A, Mucelli RMP, Rangelova E, et al. Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: a pilot study. Pancreatology. 2023;23(6):704-11.<\/li>\n<\/ol>\n\n\n\n<h2 id=\"h-como-citar-este-artigo\" class=\"wp-block-heading\"><strong>Como citar este artigo<\/strong><\/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. Pancreatectomia Central Rob\u00f3tica Guiada por Pancreatoscopia Intraoperat\u00f3ria em IPMN de Ducto Principal. Endoscopia Terapeutica, 2026 Vol II. Dispon\u00edvel em: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?p=21958\" target=\"_blank\" rel=\"noopener\">https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/pancreatoscopia-intraoperatoria-pancreatectomia-central-ipmn\/<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Autores: William Marchelli Vilela Costa, Gabrieli Melissa Oissa , Gustavo Ferreira Araruna, Sebastian Naschold&hellip;<\/p>\n","protected":false},"author":5981,"featured_media":21959,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[294,500,889],"ano":[847],"tipo":[155],"volume":[147],"class_list":["post-21958","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","tag-cpre","tag-ipmn","tag-pancreatoscopia","ano-847","tipo-cpre","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v28.5) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Pancreatoscopia intraoperat\u00f3ria em IPMN de ducto principal<\/title>\n<meta name=\"description\" content=\"Caso de IPMN de ducto principal tratado por pancreatectomia rob\u00f3tica com pancreatoscopia intraoperat\u00f3ria para mapear les\u00f5es e definir margens.\" \/>\n<meta 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