Robotic surgery of the pancreas

Abstract

Pancreatic surgery is one of the most challenging and complex fields in general surgery. While minimally invasive surgery has become the standard of care for many intra-abdominal pathologies the overwhelming majority of pancreatic surgery is performed in an open fashion. This is attributed to the retroperitoneal location of the pancreas, its intimate relationship to major vasculature and the complexity of reconstruction in the case of pancreatoduodenectomy. Herein, we describe the application of robotic technology to minimally invasive pancreatic surgery. The unique capabilities of the robotic platform have made the minimally invasive approach feasible and safe with equivalent if not better outcomes (e.g., decreased length of stay, less surgical site infections) to conventional open surgery. However, it is unclear whether the robotic approach is truly superior to traditional laparoscopy; this is a key point given the substantial costs associated with procuring and maintaining robotic capabilities.

Robotic Pancreatic Resections: Feasibility and Advantages

“…Considering the described technical advances of robotic surgery, it is evident that lymph node dissection can be carried out sufficiently by the robot. The published data indicate a mean amount of 13-32 harvested lymph nodes during robotic PD [5,6]. The reconstruction by the surgeon and here especially the pancreaticojejunostomy are further key players for successful PD.…”

“…The missing haptic feedback can lead to pancreatic tissue injuries/tear caused by too much tension during knotting or the thread can break easily. The published fistula rates after robotic PD are between 6.6-35 % [6].…”

“…Based on the current published experience, it is evident that robotic pancreatic surgery and especially PD can be performed safely and is appropriate in experienced hands [5,6]. The technical innovation with its ergonomic benefits has improved minimally invasive surgery a lot and is especially useful in complex operations such as PD.…”

“…Robotic PD leads to a decreased blood loss (153-394 ml) as it is described in Table 1. Hospitalization (9.8-16.4 days), morbidity (26-50 %), and mortality (0-3 %) do not change between open and robotic procedures in some series (Table 1) [5,6]. However, several studies reported a significantly shorter length of hospital stay when compared to open PD (9.79 vs. 13.26 days, P=0.043) and noted a significantly lower postoperative complication rate following robotic PD (25 vs. 75 %, P=0.05) [5].…”

“…This can become a problem in smaller centers with less volume. The mean operation time is elongated for PD by the robot (421-780 min) [6]. Even setting the robot prior and after the operation needs time and prolongs the procedure.…”