Robotic versus open pancreatoduodenectomy: a propensity score-matched analysis based on factors predictive of postoperative pancreatic fistula

Napoli, Niccolò; Kauffmann, Emanuele Federico; Menonna, Francesca; Costa, Francesca; Iacopi, Sara; Amorese, G; Giorgi, Serena; Baggiani, Angelo; Boggi, Ugo

doi:10.1007/s00464-017-5798-0

Cited by 36 publications

(23 citation statements)

References 52 publications

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“…However, over the past decade there has been renewed interest in LPD, especially from a small number of surgeons practicing at high‐volume specialized centres . Nonetheless, due to the technical complexity of LPD, especially during the reconstruction phase, robotic assistance has been proposed as an alternative to LPD and has been adopted by several institutions . The emergence of the use of robotic surgery (RS) for pancreatectomies in recent years has provided a viable alternative to the open and laparoscopic methods .…”

Section: Introductionmentioning

confidence: 99%

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Goh

Low

Kam

et al. 2019

ANZ Journal of Surgery

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Background: Concerns have been raised about the safety of minimally invasive surgery (MIS) for pancreatoduodenectomy (PD) during the early learning phase. In this study, we present our initial experience with MIS for periampullary tumours. Methods: Retrospective review of the first 30 consecutive patients who underwent laparoscopic (LS)/robotic surgery (RS) for periampullary tumours between 2014 and 2017. Results: Twenty-seven patients underwent PD, including three total pancreatectomies (TPs) and three underwent palliative bypasses. Twenty underwent LS, of which 18 were hybrid PDs, including two TPs and two bypasses. Ten patients underwent RS, of which nine were PDs, including one TP and one bypass. Five of 10 RSs were totally MIS procedures. There were four PDs with venous resection, of which three were by RS. There were four (13.3%) open conversions all in the LS cohort. There were five (16.7%) major (>grade 2) morbidities, including three pancreatic fistulas (two grade B and one grade C). There was no 30-day and one (3.3%) 90-day mortality. Comparison between RS and LS demonstrated that RS had a higher likelihood of being completed via totally MIS (five (50%) versus 0, P = 0.002), tended to have a shorter post-operative stay (eight (range 6-36) versus 14.5 (range 6-62) days, P = 0.058) but tended to be associated with a longer operation time (670 (range 500-930) versus 577 (range 235-715) min, P = 0.056). Conclusion: Our initial experience demonstrated that both LS and RS can be safely adopted for the treatment of periampullary tumours. The learning curve for RS seemed to be shorter than LS as we could transition more quickly from hybrid PDs to totally MIS safely. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E137-E141 ANZJSurg.com E138 Goh et al.

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Section: Introductionmentioning

confidence: 99%

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Goh

Low

Kam

et al. 2019

ANZ Journal of Surgery

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“…Multiple single or multi-institutional retrospective studies to compare specific outcomes between robotic, laparoscopic and open approaches are reported [6,[14][15][16][18][19][20][21][22][23][24] . A large systematic review examined data from 13 retrospective series [25] .…”

Section: Discussionmentioning

confidence: 99%

“…When starting a robotic program for pancreatic surgery, a dedicated team with prior experience in open as well as minimally invasive pancreatic surgery and, first and foremost, a structured training is the key to success [5] . During the early stages of the learning curve, proficiency in DPS should be achieved [6] . However, learning curves can be considerably diminished by appropriate training, proficient mentorship and an experienced multidisciplinary team [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Robotic pancreaticoduodenectomy and splenopancreatectomy: technical aspects and review of literature

Tschuor¹,

Nagarkatti²,

Salibi³

et al. 2020

Mini-invasive Surg

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Robotic pancreatic surgery provides several advantages. Since the first report of a robotic-assisted distal pancreatectomy in 2001, total pancreatectomies, pancreatic tumor enucleations, pancreaticoduodenectomy, central pancreatectomy and Appleby procedures have been performed, indicating a promising future. The aim of this article is to describe our experience of robotic pancreatic surgery including technical aspects for pancreaticoduodenectomy and distal pancreatectomy. The current literature on feasibility, safety and early postoperative outcomes will be discussed.

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“…Robotic PD is not associated with an increased rate of fistulas. In another assessment of postoperative fistulas, Napoli and colleagues used a clinical risk score and identification of other factors predictive of postoperative fistulas [58]. Patients undergoing robotic PD and open PD were stratified into risk categories and matched by propensity scores.…”

Section: Robotic Surgery Of the Pancreasmentioning

confidence: 99%

Robotic and laparoscopic surgery of the pancreas: an historical review

Lefor

2019

BMC biomed eng

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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.

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Robotic versus open pancreatoduodenectomy: a propensity score-matched analysis based on factors predictive of postoperative pancreatic fistula

Cited by 36 publications

References 52 publications

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Robotic pancreaticoduodenectomy and splenopancreatectomy: technical aspects and review of literature

Robotic and laparoscopic surgery of the pancreas: an historical review

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