Full Robotic Distal Pancreatectomy: Safety and Feasibility Analysis of a Multicenter Cohort of 236 Patients

Abstract

Introduction. Despite the widespread use of the robotic technology, only a few studies with small sample sizes report its application to pancreatic diseases treatment. Our aim is to present the results of a multicenter study on the safety and feasibility of robot-assisted distal pancreatectomy (RDP). Materials and Methods. All RDPs for benign, borderline, and malignant diseases performed in 5 referral centers from 2008 to 2016 were included. Perioperative outcomes were evaluated. Results. Two hundred thirty-six patients were included. Spleen preservation was performed in 114 cases (48.3%). Operative time was 277.8 ± 93.6 minutes. Progressive improvement in operative time was observed over the study period. Conversion rate was 6.3%. Morbidity occurred in 102 cases (43.2%), mainly due to grade A fistulas. Reoperation was required in 10 patients. Postoperatively, 2 patients died of sepsis due to a grade C fistula. Hospital readmission was necessary in 11 cases. A R0 resection was always achieved, with a mean number of 16.2 ± 15 harvested lymph nodes. Conclusion. To our knowledge, this is one of the largest RDP series. Safety and feasibility including the low conversion rate, the high spleen preservation rate, the adequate operative time, and the acceptable morbidity and mortality rates confirm the validity of this technique. Appropriate oncological outcomes have been also obtained.

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

“…A minimally invasive approach is considered technically available, safe and feasible for DP in the treatment of leftside pancreatic tumors [5,[26][27][28][29]. As an inevitable part of minimally invasive DP, RDP has been frequently analyzed in observational studies, and a series of reports have indicated that RDP results in a shorter operative duration, less blood loss, shorter postoperative hospital stay, higher spleen preservation rate, and comparable morbidity and mortality rates [30][31][32][33][34].…”

100 Robotic Distal Pancreatectomies: The Future at Hand

“…Although several studies have looked at clinical outcomes following robotic distal pancreatectomy, these reviews have only been introspective and generally small. 4,[8][9][10][11] The optimal surgical approach to a distal pancreatectomy has been debated since it became apparent that minimally invasive modalities were a viable choice for the skilled surgeon. This manuscript addresses and justifies the role of the robotic platform to complex abdominal operations such as distal pancreatectomy.…”

“…1,2 More recently, minimally invasive approaches (eg, laparoscopy) for pancreatic resections have shown tremendous improvements in patient outcomes including shorter lengths of confinement and quicker returns to functional activities. [3][4][5] With laparoscopic approaches becoming broadly adopted, it became indisputable that complex pancreatic and hepatobiliary surgery through minimally invasive techniques was possible; nonetheless, the question remained: is it practical? Unfortunately, laparoscopy has a number of inherent limitations that hinder its application to many complex operations, especially those requiring some form of reconstruction.…”

“…6 Beginning in the new millennium, reports describing the application of the robotic platform to distal pancreatectomy began to appear. 1,2,4,5,7 With the release of the Xi model of the Intuitive Surgical, Inc robot in 2014, there began an accelerated adoption of the robotic platform because of its inherent advantages over laparoscopy. These advantages include elimination of hand tremor, 7 degrees of motion resulting in increased dexterity, excellent ergonomics, 3-dimensional high-definition optics, a stable camera, improved energy sources, and the ability to undertake more accurate dissection.…”

La inteligencia artificial y sus aplicaciones en medicina II: importancia actual y aplicaciones prácticas

“…Muchas de sus predicciones reflejaban el conocimiento clínico que tendría un cirujano, pero este algoritmo también fue capaz de ajustar frases que describen a los pacientes (por ejemplo, irritado, cansado) en el primer día del postoperatorio para lograr predicciones con una sensibilidad del 100% y una especificidad del 72% 32 . El uso de los robots quirúrgicos, visto anteriormente, es una realidad cotidiana en nuestro medio, sobre todo en cirugía prostática 33 , colorrectal 34 o pancreática 35 al considerarse un método menos invasivo. Además de los desarrollos comerciales existentes, se están desarrollando sistemas de asistencia robótica en cirugía de código abierto como el sistema Raven II que será probado en diferentes universidades estadounidenses 36 .…”