Revisiting the potential advantage of robotic surgical system in spleen-preserving distal pancreatectomy over conventional laparoscopic approach

Abstract

Background: This study aimed to compare success rate of spleen preservation between robotic and laparoscopic distal pancreatectomy (DP).Methods: Between November 2007 and March 2018, forty-one patients underwent the conventional laparoscopic DP (Lap group) and the other 37 patients underwent robotic DP (Robot group). The perioperative clinicopathologic variables were compared. Results:The robotic procedure was chosen by younger patients compared to conventional laparoscopic surgery (42.9±14.0 vs. 51.3±14.6 years, P=0.016). The mean operation time was longer (313 vs. 246 min, P=0.000), but the mean tumor size was smaller in Robot group (2.7±1.2 vs. 4.2±3.3 cm, P=0.018). The overall spleen-preserving rate was higher in the Robot group (91.9% vs. 68.3%, P=0.012). However, with accumulating laparoscopic experiences (after 16th case), the statistical differences in spleen preservation rate between the Robot and Lap groups had diminished (P=0.428). Conclusions:The present results suggest a robot can be helpful to save the spleen during DP for benign and borderline malignancy. However, a surgeon highly experienced in the laparoscopic approach can also produce a high success rate of spleen preservation, similar to that shown with the robotic approach.

Minimally invasive distal pancreatectomy: a case-matched cost-analysis between robot-assisted surgery and direct manual laparoscopy

“…Another aspect which deserves to be highlighted among the positive impact of the RAS versus the DML on the outcomes of the distal pancreatectomy, although difficult to quantify within a cost analysis, is the higher spleen preservation rate. In this regard, our data are in line with literature [ 2 , 7 , 17 , 33 ], as the greater effectiveness of robotic system in controlling splenic vessels bleeding resulted in a higher spleen preservation rate associated with RDP among patients scheduled for spleen preservation with respect to LDP. This outcome is important not only for the biological benefit of spleen preservation, but also as the reduced use of stapler and stapler charges, necessary for the section of the splenic vessel in case of splenectomy, could contribute to reduce the CCs of RDP.…”

“…Robotic distal pancreatectomy (RDP) seems also to be associated with an additional positive impact on the clinical outcomes as well, with a reduction of conversion rates, higher spleen preservation rates, and a shorter LOS [2,6,7]. A potential barrier to the diffusion of the robotic approach could be its economic impact [8]; indeed, it is well known that RAS is generally associated with higher costs in comparison to direct manual laparoscopy (DML), also for RDP, as data emerged from previous studies, although controversial, are almost unanimously oriented toward higher cost for RAS [3,[9][10][11][12][13][14].…”

A Prognostic Impact of Splenectomy in Laparoscopic Distal Pancreatectomy on Benign/Borderline Pancreatic Tumors: A Change of the Era

“… 23 However, according to recent meta-analyses, 24 25 the usefulness of robots in spleen preservation was reported to be similar to that of laparoscopy, and we authors also confirmed this in previous research. 26 Rather, it was thought that the robots would be more useful in performing single-site plus one port DP, 27 28 29 30 a concept of reduced port, in well-selected patients during DP requiring concomitant splenectomy. Further research is required regarding the application of robotic surgery on DP.…”

Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

“…The first robotic-assisted distal pancreatectomy for the treatment of p-NETs was reported in 2002 using the DaVinci ® (Intuitive Surgical, Sunnyvale, CA, USA) robotic surgical system [ 37 ]. Robotic assistance was helpful to increase the spleen preservation rate in distal pancreatectomy due to better depth perception owing to the use of three-dimensional representation, tremor elimination and seven degrees freedom of movement [ 38 , 39 ].…”