Background: A minimal distance of 3 mm to main pancreatic duct (MPD) was generally considered to be necessary for pancreatic enucleation (PE). This study was designed to report the safety and feasibility of PE for tumors located in 3 mm to MPD Under the intraoperative ultrasound (IOUS) guidance. Methods: The data of patients who received IOUS guided robotic PE from January 2018 to May 2019 in the second department of hepato-pancreato-biliary surgery were reviewed in this study. According to the distance to MPD (less than 3 mm or not), patients were divided in 2 groups, and the short-term operative outcomes were compared. Statistics: Students’ t-test and Mann-Whitney U test were used for comparing continuous variables, and Chi-squared test was used for comparing categorical variables. Results: And a total of 56 patients were analyzed, and a minimal distance less than 3 mm between the tumor and pancreatic duct measured by IOUS was found in 12 patients. The tumors and MPD were clearly revealed intraoperatively in all the cases. The operative duration was significantly longer in patients with tumors located in 3 mm from MPD (143.25 ± 40.89 min vs 107.14 ± 37.73 min, t = 2.756, P=.014). There was no significant difference between the rate of post-operative pancreatic fistula and other complications in the different groups (χ2 =.924, P=.48). Discussion and conclusion: robotic PE could be safely performed under IOUS guidance for benign or low-grade malignant tumors located less than 3 mm to the MPD.

Background There has been data from meta-analysis suggesting that RAMPS is a safe and effective procedure for adenocarcinoma in the body or tail of the pancreas and is oncologically superior to SRPS. However, previous studies on RAMPS were conducted under the open and laparoscopic surgery. Robotic surgery, on the other hand, plays a role in ergonomics and offers several advantages, including less fatigue, tremor filtering, 7° of wrist-like motion, motion scaling, and three-dimensional vision. At present, there is still a lack of clinical studies to observe the safety and clinical efficacy of Robotic RAMPS in the world. Hence,prospective randomized controlled trials (RCTs) comparing Robotic RAMPS and SRPS are required. We begin a RCT trial to compare short-term surgical and oncological outcomes of Robotic RAMPS and SRPS for patients with distal pancreatectomy.Methods This is a randomized, single-center clinical trial. All included adults are patients with primary carcinoma of the distal pancreatectomy. A total of 246 patients will be randomly allocated to Robotic RAMPS or SRPS. The primary endpoints are oncological outcomes(R0 rate, number of Lymph node). Secondary endpoints are the perioperative complications, Perioperative indicators(operative time,blood loss,blood transfusion volume,costs).Discussion To evaluate the surgical and oncological outcomes of Robotic RAMPS, we therefore undertake a prospective RCT. This procedure may become a standard approach to robotic pancreatosplenectomy.

Background There has been data from meta-analysis suggesting that RAMPS is a safe and effective procedure for adenocarcinoma in the body or tail of the pancreas and is oncologically superior to SRPS. However, previous studies on RAMPS were conducted under the open and laparoscopic surgery. Robotic surgery, on the other hand, plays a role in ergonomics and offers several advantages, including less fatigue, tremor filtering, 7° of wrist-like motion, motion scaling, and three-dimensional vision. At present, there is still a lack of clinical studies to observe the safety and clinical efficacy of Robotic RAMPS in the world. Hence,prospective randomized controlled trials (RCTs) comparing Robotic RAMPS and SRPS are required. We begin a RCT trial to compare short-term surgical and oncological outcomes of Robotic RAMPS and SRPS for patients with distal pancreatectomy.Methods This is a randomized, single-center clinical trial. All included adults are patients with primary carcinoma of the distal pancreatectomy. A total of 246 patients will be randomly allocated to Robotic RAMPS or SRPS. The primary endpoints are oncological outcomes(R0 rate, number of Lymph node). Secondary endpoints are the perioperative complications, Perioperative indicators(operative time,blood loss,blood transfusion volume,costs).Discussion To evaluate the surgical and oncological outcomes of Robotic RAMPS, we therefore undertake a prospective RCT. This procedure may become a standard approach to robotic pancreatosplenectomy.

Background: Data from meta-analysis suggest that robotic radical antegrade modular pancreatosplenectomy (RAMPS) is a safe and effective procedure for treating adenocarcinoma in the body or tail of the pancreas, and is oncologically superior to standard retrograde pancreatosplenectomy (SRPS). RAMPS is an operation that actively expands the scope of resection, and achieves a higher R0 resection rate and lymph nodes acquisition through expanded resection. However, previous studies on RAMPS were conducted under open and laparoscopic surgery. Robotic surgery, on the other hand, plays a role in ergonomics and offers several advantages, including less fatigue, tremor filtering, 7°of wrist-like motion, motion scaling, and three-dimensional vision. At present, there is still a worldwide lack of clinical studies to observe the safety and clinical efficacy of robotic RAMPS. Hence, prospective randomized controlled trials (RCTs) comparing robotic RAMPS and SRPS are required. We begin an RCT to compare short-term surgical and oncological outcomes of robotic RAMPS and SRPS in patients undergoing distal pancreatectomy. Methods: This is a randomized, single-center clinical trial. All participants are adult patients with primary pancreatic cancer, who are undergoing RAMPS or SRPS. The primary endpoints are R0 rate (resection margins are classified by a margin to tumor distance ≥ 1 mm). The secondary endpoints are the number of harvested lymph nodes, perioperative complications and perioperative indicators (duration of surgery, blood loss, blood transfusion volume, costs). Discussion: We are undertaking a prospective RCT to evaluate the surgical and oncological outcomes of robotic RAMPS. This procedure may become a standard approach to robotic pancreatosplenectomy.