500 Minimally Invasive Robotic Pancreatoduodenectomies

Abstract

Objectives: This study aims to present the outcomes of our decade-long experience of robotic pancreatoduodenectomy and provide insights into successful program implementation. Background: Despite significant improvement in mortality over the past 30 years, morbidity following open pancreatoduodenectomy remains high. We implemented a minimally invasive pancreatic surgery program based on the robotic platform as one potential method of improving outcomes for this operation. Methods: A retrospective review of a prospectively maintained institutional database was performed to identify patients who underwent robotic pancreatoduodenectomy (RPD) between 2008 and 2017 at the University of Pittsburgh. Results: In total, 500 consecutive RPDs were included. Operative time, conversion to open, blood loss, and clinically relevant postoperative pancreatic fistula improved early in the experience and have remained low despite increasing complexity of case selection as reflected by increasing number of patients with pancreatic cancer, vascular resections, and higher Charlson Comorbidity scores (all P<0.05). Operating room time plateaued after 240 cases at a median time of 391 minutes (interquartile rang 340–477). Major complications (Clavien >2) occurred in less than 24%, clinically relevant postoperative pancreatic fistula in 7.8%, 30- and 90-day mortality were 1.4% and 3.1% respectively, and median length of stay was 8 days. Outcomes were not impacted by integration of trainees or expansion of selection criteria. Conclusions: Structured implementation of robotic pancreatoduodenectomy can be associated with excellent outcomes. In the largest series of RPD, we establish benchmarks for the surgical community to consider when adopting this approach.

How to train and evaluate minimally invasive pancreas surgery

“…The majority of data regarding robotic training and building a comprehensive surgical oncology robotic center 40 has come from the University of Pittsburgh, which recently reported their experience with 500 robotic pancreaticoduodenectomies (RPD) 41 . In addition, the development of Fundamentals of Robotic Surgery which includes 25 outcomes measures required by a surgeon to safely perform robotic surgery regardless of specialty has been proposed.…”

Robotisch assistierte obere gastrointestinale und hepatopankreatobiliäre Chirurgie: Etablierung durch einen Stepwise Approach und eine Analyse der ersten 100 Operationen

“…Die Arbeitsgruppe in Pittsburgh veröffentlichte vor Kurzem mit 500 Eingriffen die bislang größte Serie robotisch assistierter PD. Hier lagen die Mortalität bei 3,1 %, die Morbidität bei 24 %, die Reoperationsrate bei 26 % und die Konversionsrate bei 26 % [20].…”

Robotic Pancreatoduodenectomy: Patient Selection, Volume Criteria, and Training Programs

“…Are there contraindications or is RPD safe/superior for all indications? (3–8). Second, is there a minimum annual volume for safe implementation of RPD.…”

“…This highlights the importance of specific training programs for RPD to shorting the learning curve and minimize or even exclude any patient risk during this phase. This review describes the training programs for RPD and other robot pancreas surgery found in the literature (4, 16–18).…”