Robotic and laparoscopic surgery of the pancreas: an historical review

Abstract

Surgery of the pancreas is a relatively new field, with operative series appearing only in the last 50 years. Surgery of the pancreas is technically challenging. The entire field of general surgery changed radically in 1987 with the introduction of the laparoscopic cholecystectomy. Minimally Invasive surgical techniques rapidly became utilized worldwide for gallbladder surgery and were then adapted to other abdominal operations. These techniques are used regularly for surgery of the pancreas including distal pancreatectomy and pancreatoduodenectomy. The progression from open surgery to laparoscopy to robotic surgery has occurred for many operations including adrenalectomy, thyroidectomy, colon resection, prostatectomy, gastrectomy and others. Data to show a benefit to the patient are scarce for robotic surgery, although both laparoscopic and robotic surgery of the pancreas have been shown not to be inferior with regard to major operative and oncologic outcomes. While there were serious concerns when laparoscopy was first used in patients with malignancies, robotic surgery has been used in many benign and malignant conditions with no obvious deterioration of outcomes. Robotic surgery for malignancies of the pancreas is well accepted and expanding to more centers. The importance of centers of excellence, surgeon experience supported by a codified mastery-based training program and international registries is widely accepted. Robotic pancreatic surgery is associated with slightly decreased blood loss and decreased length of stay compared to open surgery. Major oncologic outcomes appear to have been preserved, with some studies showing higher rates of R0 resection and tumor-free margins. Patients with lesions of the pancreas should find a surgeon they trust and do not need to be concerned with the operative approach used for their resection. The step-wise approach that has characterized the growth in robotic surgery of the pancreas, in contradistinction to the frenzy that accompanied the introduction of laparoscopic cholecystectomy, has allowed the identification of areas for improvement, many of which lie at the junction of engineering and medical practice. Refinements in robotic surgery depend on a partnership between engineers and clinicians.

The Landmark Series: Minimally Invasive Pancreatic Resection

“…1,2 This has resulted in numerous case-series and registry studies on minimally invasive distal pancreatectomy (MIDP) and minimally invasive pancreatoduodenectomy (MIPD). [3][4][5][6][7][8][9][10][11] These studies reported less intraoperative blood loss, lower morbidity, and shorter hospital stay after MIPR (compared with the conventional open approach). However, there were also some concerns caused by high conversion rates, inferior oncological outcomes, and increased mortality reported in low-volume centers; these concerns hampered further widespread introduction of MIDP and MIPD.…”

The effect of simulator fidelity on procedure skill training: a literature review

“…Training in robotic surgery is emphasized in contrast to what happened when laparoscopic surgery was introduced. 2 Simulators designed for robotic-assisted surgery training are generally high-fidelity, large and expensive because they closely resemble the actual daVinci robotic-assisted surgical system robot (Intuitive, Sunnyvale CA) which is the most commonly used system. A reasonably low-cost portable VR trainer for the daVinci system was recently described.…”

“…1 Laparoscopic surgery training in the late 1980s and early 1990s often proceeded without verification of skills or competency. 2 Since that time, training to perform procedures has undergone widespread change and simulation has become an important component. Selecting the optimal simulator for a specific procedure and trainee group is difficult.…”

Introductory Chapter: Endoscopy and ERAS

“…It has been reported that patients with benign disease were hospitalized for 5 days after major Although laparoscopic hepatectomy is widely used in most HPB centers, especially in atypical or wedge resection, laparoscopic techniques are not applied at the same speed in pancreatectomy. In particular, the application of laparoscopic surgery in complex operations such as pancreaticoduodenectomy, even in the leading institutions of robotic surgery, has not shown an improvement in length of hospitalization or morbidity, which needs further data to demonstrate [31,32].…”