Recent Developments in Surgery

Abstract

Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minimally invasive pancreaticoduodenectomy, including robotic techniques. Herein, we provide a retrospective review of all published studies in the English literature in which a minimally invasive pancreaticoduodenectomy was performed. The reported advantages of minimally invasive pancreaticoduodenectomy include better visualization, faster recovery time, and decreased length of hospital stay. In cases of robotic approaches, some of the proposed advantages include increased dexterity and a superior ergonomic position for the operating surgeon. To our knowledge, few studies have reported results comparable to open techniques in oncologic outcomes with regard to the number of lymph nodes resected and clear margins obtained. An increasing number of pancreatic resections are being performed using minimally invasive approaches. It remains to be determined if the benefits of this technique outweigh its longer operative times and higher costs.

The State of the Art of Robotic Pancreatectomy

“…The robot offers advantages in terms of 3D vision, dexterity, and ergonomy [10]. Giulianotti and coworkers described the first robotic PD in 2003 [11].…”

“…The introduction of the robot increased the interest in many centers for minimally invasive pancreatic surgery, even in performing more complicated operations. The improved 3-dimensional imaging, the enhanced dexterity, the better visualization and increased magnification, and the improved ergonomics associated with robotic surgery [10] are some of the most important reasons for the development of robotic pancreatic surgery. The robot offers also the possibility of performing a minimally invasive operation in a way much more similar to traditional open surgery compared to the laparoscopic approach.…”

Oncologic and Perioperative Outcomes Following Selective Application of Laparoscopic Pancreaticoduodenectomy for Periampullary Malignancies

“…4-14 In fact, reduced blood loss, need for transfusion, and shorter hospital stays appear to be consistent advantages associated with laparoscopic PD (LPD). 15 Most recently, Kendrick et al reported that LPD performed for malignancy may be associated with improved long-term survival. 14 …”

Minimally invasive surgical treatment of carcinoma of the papilla of Vater: A case report

“…The fact that the laparoscopic resection of the pancreatic head is performed exclusively in the highly specialized and high-frequency centers worldwide indicates the level of complexity and technical demands required for such procedures (9). The post-operative course was apparently different from the course of conventional open surgical procedures, namely, by the reduced time of patient's recovery due to minimal trauma, and the reduced time to getting the patient to a vertical position.…”

“…Operating time was slightly longer with laparoscopic procedures compared to the classical method and the number of post-operative days is lower in the laparoscopic compared to the conventional surgery (13). The percentage of post-operative complications is significantly reduced due to the non-existence of surgical wound infections (9). A minimally invasive approach is reserved for pathologically well-differentiated cases, with a clear picture of the surrounding infiltrations and anatomical variations.…”