Robotic distal pancreatectomy: Cost effective?

Waters, Joshua A.; Canal, David F.; Wiebke, Eric A.; Dumas, Ryan P.; Beane, Joal D.; Aguilar-Saavedra, Juan R.; Ball, Chad G.; House, Michael G.; Zyromski, Nicholas J.; Nakeeb, Attila; Pitt, Henry A.; Lillemoe, Keith D.; Schmidt, C. Max

doi:10.1016/j.surg.2010.07.027

Cited by 222 publications

(273 citation statements)

References 28 publications

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“…No margin was positive. For patients with HCC, the mean surgical margin was 13 mm (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and for colorectal metastases, it was 25 mm (range 5-70) [16]. All these suggest that oncological efficacy can be achieved even in robotic liver resections.…”

Section: Median (Range)mentioning

confidence: 92%

“…Due to the complex nature of the surgery and demanding technical skills, laparoscopic pancreatectomy has not received widespread acceptance since its introduction in 1994. It is also associated with a fairly high conversion rate, from 0 to 40%, and pancreatic fistula formation ranging between 7 and 60% [6,9,26].…”

Section: Median (Range)mentioning

confidence: 99%

“…Comparable length of stay, blood loss and operating time could be achieved. Waters et al [6] reported in a retrospective review comparing open, laparoscopic and robotic distal pancreatectomies that robotic surgery required significantly longer operating time (mean 298, 191-418 min) but shorter length of stay (mean 4, 2-6 days). There were no significant differences in mean blood loss (279, 20-1200 mL), conversion rate (n = 2, 12%), mortality (n = 0) and morbidity (n = 3, 18%).…”

Section: Median (Range)mentioning

confidence: 99%

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Robotic hepatobiliary and pancreatic surgery: a cohort study

Chan

Tang

Lai

et al. 2011

J Hepato Biliary Pancreat

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Background Robotic surgery has emerged as one of the most promising surgical advances since its launch at the turn of the millennium. Despite its worldwide acceptance in many different surgical specialties, the use of robotic assistance in the field of hepatobiliary and pancreatic (HBP) surgery remains relatively unexplored. This article aims to evaluate the efficacy and outcomes of robotic HBP surgery in a single surgical center. Methods Between May 2009 and December 2010, all patients admitted to our unit for robotic HBP surgery were evaluated. A retrospective analysis of a prospectively maintained database on clinical outcomes was performed. Results There were 55 robotic HBP operations performed during the study period. There were 27 robotic liver resections (left lateral sectionectomies n = 17, left hepatectomy n = 1, other segmentectomies n = 2 and wedge resections n = 7), 12 robotic pancreatic procedures (Whipple's operations n = 8, spleen-preserving distal pancreatectomies n = 2, double bypass n = 1 and cystojejunostomy n = 1) and 16 biliary procedures (biliary enteric bypass n = 9, bile duct exploration and related procedures n = 7). The median postoperative hospital stays for robotic liver resections, biliary procedures and pancreatic operations were 5.5 days (range 3-11 days), 6 days (range 4-11 days) and 12 days (range 6-21 days), respectively. Morbidities for liver resection, biliary procedures and pancreatic operations were 7.4, 18 and 33%, respectively. There was no mortality in our series.Conclusions Robotic surgery is feasible and can be safely performed in patients with complicated HBP pathologies. Further evaluation with clinical trials is required to validate its real benefits.

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Section: Median (Range)mentioning

confidence: 92%

Section: Median (Range)mentioning

confidence: 99%

Section: Median (Range)mentioning

confidence: 99%

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Robotic hepatobiliary and pancreatic surgery: a cohort study

Chan

Tang

Lai

et al. 2011

J Hepato Biliary Pancreat

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“…One of the major concerns about robotic surgery is of course cost. Data about costs are lacking and have been explored in a limited manner for single procedures such as distal pancreatectomy [29]. Short hospital stays deriving from minimally invasive procedures do translate into cost cuts for health care institutions, although whether the robotic platform is overall cost-effective is more difficult to evaluate.…”

Section: Discussionmentioning

confidence: 99%

“…Waters et al [29] have reported a series of 77 distal pancreatectomies showing a slightly longer operative time for the robotic-assisted procedures (298 vs. 222 min) but less blood loss (279 vs. 661 ml). The spleen preservation rate was 65 % in the robotic-assisted group and 29 % in the laparoscopic one.…”

Section: Robotic-assisted Distal Pancreatectomymentioning

confidence: 99%

Robotic‐assisted pancreatic surgery

Fernandes

Giulianotti

2013

J Hepato Biliary Pancreat

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Background Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. Methods As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. Results Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. Conclusion Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short-and long-term outcomes seem to be similar to the ones achieved in open surgery.

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Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy

et al. 2014

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IMPORTANCE Interest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomes may begained from a national database inquiry OBJECTIVES To study trends in the use of MIDP and compare the short-term outcomes of MlDPwith those of open distal pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient- and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals MAIN OUTCOMES AND MEASURES In-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay. RESULTS A total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4 3%) were MIDPs. On a national level, this projected to 42 320 open distal pancreatectomies and 1908 MlDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2 4% to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MlDPwere 15 years older. On multivariate analysis. MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges CONCLUSIONS AND RELEVANCE This population-based study of MlDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.

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Robotic distal pancreatectomy: Cost effective?

Cited by 222 publications

References 28 publications

Robotic hepatobiliary and pancreatic surgery: a cohort study

Robotic hepatobiliary and pancreatic surgery: a cohort study

Robotic‐assisted pancreatic surgery

Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy

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