Distal Pancreatectomy: A Single Institution's Experience in Open, Laparoscopic, and Robotic Approaches

Lee, Ser Yee; Allen, Peter J.; Sadot, Eran; D’Angelica, Michael I.; DeMatteo, Ronald P.; Fong, Yuman; Jarnagin, William R.; Kingham, T. Peter

doi:10.1016/j.jamcollsurg.2014.10.004

Cited by 176 publications

(192 citation statements)

References 49 publications

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“…From this large, multicenter matched cohort study, it became clear that LDP was not only feasible, but could also offer additional benefits as compared to the open approach. Since 2008, these findings have been corroborated by numerous single center [8][9][10][11][12] and multicenter reports [13,14], as well as those of several meta-analyses [4,15].…”

mentioning

confidence: 63%

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Kooby

Vollmer

2015

J Hepato Biliary Pancreat

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Laparoscopic approaches exist for most operations traditionally performed using open techniques, and an increasing number of organ resections are being performed laparoscopically. The potential benefits of laparoscopic over the open approach include reduced operative blood loss, fewer surgical complications, shorter hospital stays, and faster recovery times. Cholecystectomy and adrenalectomy are two such examples of organ resections more commonly performed laparoscopically than open in the United States, as the complexity of these operations is relatively low for experienced surgeons in properly selected patients. Laparoscopic colectomy had a slower evolution given the increased complexity of the procedure, but the value of the laparoscopic approach was demonstrated through several multicenter randomized trials [1,2], facilitated by the relatively large number of colectomies performed annually.Momentum for minimally invasive pancreatectomy (MIP) has been slower -likely due to the retroperitoneal location of the organ, its intimate relationship with the main mesenteric vessels, the complexity of the surgery, the inherent risk of postoperative pancreatic fistula (POPF) formation, and the relatively lower volume of cases, as compared with cholecystectomy and colectomy [3]. Of pancreatic resections, distal pancreatectomy (DP) is the most commonly achieved laparoscopically [4]. First reported in 1994, laparoscopic distal pancreatectomy (LDP) is being performed with increasing frequency worldwide despite a lack of randomized data supporting this approach over standard open distal pancreatectomy (ODP). Approximately one quarter of all DPs are performed using minimally invasive approaches [5].Drs Nakamura and colleagues from 69 medical centers in Japan used a sophisticated statistical method (propensity score matching -PSM) to address the comparison of two surgical techniques (LDP and ODP) for removing the left side of the pancreas [6]. The key findings between the two cohorts after PSM are that compared with ODP, LDP is associated with lower blood loss (254 ± 384 vs. 499 ± 740, <0.001), fewer blood transfusion (4% vs. 6.8%, P = 0.02), fewer grade B and C POPF (18.4% vs. 28.2%, P < 0.001), a higher percentage of splenic preservations (29.9% vs. 13.2%, P < 0.001), and shorter hospital stays (18.8 ± 14.7 vs. 23.2 ± 18.8, P = 0.001). In great part, these results support data from prior studies.In 2008 Results of this study demonstrated that there were no significant differences in OR time (216 vs. 230 min; P = 0.3), development of major pancreatic fistula (18% vs. 11%; P = 0.1), major complication (17% vs. 10%; P = 0.08), or 30-day mortality (1% vs. 0%; P = 0.040) between the groups (ODP vs. LDP, respectively). As compared with ODP, LDP was associated with lower estimated blood loss

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mentioning

confidence: 63%

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Kooby

Vollmer

2015

J Hepato Biliary Pancreat

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“…(11,14,17,36) However, this minimally invasive procedure remains technically demanding, especially when splenic preservation is required; open conversion rates are significant (up to 30%) even in highvolume, experienced centres. (16) The rate of splenic preservation has a reported range of 32%-84%. (14) To date, the reported use of RDP worldwide is rare.…”

Section: Casementioning

confidence: 99%

“…(14,15) Despite the increased adoption of LDP, there are barriers to its widespread adoption, which include the significant risk of conversion to the hand-assisted or open approach. (15,16) Robotic surgery was introduced to overcome the shortcomings of conventional laparoscopic surgery. (11,15,17) The robotic platform provides a three-dimensional, high-definition, magnified view of the operative field.…”

mentioning

confidence: 99%

First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases

Goh

Wong

Chan

et al. 2016

smedj

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INTRODUCTIONOver the past few decades, the use of laparoscopic surgery has expanded rapidly to become the surgical approach of choice for many abdominal operations, including cholecystectomies, (1) appendicectomies, (2) adrenalectomies,colectomies (4) and gastric resections.(5,6) However, the adoption of laparoscopic surgery in the fields of liver and pancreatic surgery has been relatively slow. (7,8) Although the first laparoscopic liver and pancreatic resections were reported in the early 1990s, (9,10) widespread adoption of such operations has been hindered by the technical complexities of these procedures, and concerns about oncological margins and risk of bleeding. (8) Pancreatic surgery is among the most complex and challenging of all abdominal operations.(11) Despite rapid surgical advancements, pancreatic surgery remains a challenge and is associated with a high morbidity rate worldwide, even in highly specialised and experienced tertiary centres.(12,13) Laparoscopic pancreatic surgery was first reported by Cuschieri in 1994.(9) Since then, a growing number of studies on laparoscopic pancreatic surgeries have been published, although it has yet to gain widespread acceptance.(11) As distal pancreatectomy (DP) is not as technically demanding as pancreaticoduodenectomy, it is not surprising that most of the published studies are on the outcomes of laparoscopic DP (LDP). (14) These early studies have reported the potential benefits of using the laparoscopic approach, including decreased pain and blood loss, faster recovery, and a shorter hospital stay; the laparoscopic approach is also associated with morbidity rates that are similar to those observed with the use of the open approach. (14,15) Despite the increased adoption of LDP, there are barriers to its widespread adoption, which include the significant risk of conversion to the hand-assisted or open approach. (15,16) Robotic surgery was introduced to overcome the shortcomings of conventional laparoscopic surgery. (11,15,17) The robotic platform provides a three-dimensional, high-definition, magnified view of the operative field. It also provides the additional advantages of improved dexterity and precision due to increased freedom of movement and the elimination of tremors. (7,11) The superiority of robotic surgery over conventional laparoscopy when performing complex surgical tasks has been proven in ex vivo models. (15) However, its use in the clinical setting remains controversial, especially with regard to DP. In the first series of robotic distal pancreatectomies (RDPs), reported by Giulianotti et al in 2003, 13 patients underwent RDP. (18) Several studies on RDP have since been reported, most of which were small case series involving less than 50 patients. (17)

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“…Conversion rate ranged from 0% to 34% (18,19), hemorrhage and failure to progress being the most common causes. Estimated intraoperative blood loss was found to be significantly lower in LDP (9,13,14,20,21).…”

Section: Distal Pancreatectomy (Dp)mentioning

confidence: 84%

Laparoscopic pancreatic resection—a review

Justin

Fingerhut²,

Khatkov³

et al. 2016

Transl. Gastroenterol. Hepatol.

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Distal Pancreatectomy: A Single Institution's Experience in Open, Laparoscopic, and Robotic Approaches

Cited by 176 publications

References 49 publications

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary?

First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases

Laparoscopic pancreatic resection—a review

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