Early experience with robot-assisted Frey’s procedure surgical outcome and technique: Indian perspective

Shukla, Ankit; Gnanasekaran, Senthil; Kalayarasan, Raja; Pottakkat, Biju

doi:10.7602/jmis.2022.25.4.145

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…Shukla et al [ 92 ] reported the feasibility of robot assisted Frey’s procedure in nine patients with chronic pancreatitis. Robotic approach is associated with less blood loss and shorter hospital stay compared to open Frey’s procedure.…”

Section: Surgical Management Of Chronic Pancreatitismentioning

confidence: 99%

Changing trends in the minimally invasive surgery for chronic pancreatitis

Kalayarasan¹,

Shukla²

2023

World J Gastroenterol

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Chronic pancreatitis is a debilitating pancreatic inflammatory disease characterized by intractable pain resulting in poor quality of life. Conventional management of pancreatic pain consists of a step-up approach with medications and lifestyle modifications followed by endoscopic intervention. Traditionally surgery is reserved for patients who do not improve with other interventions. However, recent studies suggest that early surgical intervention is more beneficial as it can mitigate the progression of the pathological process and prevent loss of pancreatic function. Despite the widespread adoption of minimally invasive approaches in various gastrointestinal surgical disorders, minimally invasive surgery for chronic pancreatitis is slow to evolve. Technical difficulty due to severe inflammatory changes has been the major impediment to the widespread usage of minimally invasive surgery in chronic pancreatitis. With this background, the present review aimed to critically analyze the available evidence on the minimally invasive treatment of chronic pancreatitis. A Pub Med search of all relevant articles was performed using the appropriate keywords, parentheses, and Boolean operators. Most initial laparoscopic series have reported the feasibility of lateral pancreaticojejunostomy, considered an adequate procedure only in a small proportion of patients. The pancreatic head is the pacemaker of pain, so adequate decompression is critical for long-term pain relief. Recent studies have documented the feasibility of minimally invasive duodenum-preserving pancreatic head resection. With improvements in laparoscopic instrumentation and technological advances, minimally invasive surgery for chronic pancreatitis is gaining momentum. However, more high-quality evidence is required to document the superiority of minimally invasive surgery for chronic pancreatitis.

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Section: Surgical Management Of Chronic Pancreatitismentioning

confidence: 99%

Changing trends in the minimally invasive surgery for chronic pancreatitis

Kalayarasan¹,

Shukla²

2023

World J Gastroenterol

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“…With the development of Devol's first robotic machines using a magnetic process controller in the 1940s, robotic surgery made immense progress in recent years[ 22 ]. Since the first robotic cholecystectomy performed by Himpens in 1997, the use of robotics in hepatobiliary and pancreatic surgery, including complex surgeries, has shown noticeable growth[ 23 , 24 ].The initial case series on the use of robots for biliary stricture repair was published by Giulianotti et al [ 11 ] in 2018, which analyzed fourteen patients. Interestingly, 42.9% of included patients had Bismuth type II injuries underscoring the careful selection of patients for the robotic approach in the initial phase.…”

Section: Robotic Repair Of Post-cholecystectomy Biliary Stricturementioning

confidence: 99%

Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives

Kalayarasan,

Sai Krishna

2023

World J Gastrointest Surg

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Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.

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