The State of the Art of Robotic Pancreatectomy

Chiaro, Marco Del; Segersvärd, Ralf

doi:10.1155/2014/920492

Cited by 23 publications

(10 citation statements)

References 33 publications

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“…There were no cases of EI or endocrine dysfunction, and Clavien grade III or higher complications occurred in one patient (11%) with no reoperations or mortality. Similar outcomes were seen in additional reports of robotic CP, indicating it is a viable approach to select central pancreas lesions in specialized centers (18,19,23,38,39) (Table 3). …”

supporting

confidence: 71%

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

2016

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Recent improvements in imaging techniques and more frequent use of cross-sectional imaging have led to an increase in the identification of benign and low-grade lesions of the pancreas. Patients with resectable cancers are commonly treated by either a Whipple procedure or distal pancreatectomy (DP) based on the location of the tumor. Central pancreatectomy (CP) is a less commonly performed operation that has recently been utilized for resection of these now more frequently diagnosed low-grade and benign lesions located in the mid pancreas. Lesions that may have a relatively more indolent nature include branchtype intraductal papillary mucinous neoplasm (IPMNs), mucinous cystic neoplasms, neuroendocrine tumors, and solid pseudopapillary tumors. The goal of a CP is complete extirpation of the lesion, while preserving pancreatic parenchyma to reduce the risks of developing diabetes and exocrine insufficiency (EI). Although open CP has been shown to be safe and efficacious, the outcomes of a minimally invasive approach are still relatively underreported and therefore unknown. In this paper, we describe our surgical approach to performing a CP with an accompanying video demonstration of the key portions of the operation. multiple anastomoses required for restoring continuity of the hepatic duct, pancreatic duct and intestinal tract (1,10). The concerns surrounding CP include high incidence of post-operative pancreatic fistula (POPF) and potentially inadequate oncologic resection in cases of malignancy (9). However, studies have shown that although the rates of POPF after CP are relatively high (20-50%), oftentimes these patients possess soft glands and small ducts, which are both well-established risk factors for POPF (9). Also, in most cases the POPF is clinically insignificant [International Study Group on Pancreatic Fistula (ISGPF) grade A] (9). Therefore, CP is a reasonable approach for centrally located, benign or low-grade pancreatic lesions that allows preservation of pancreas parenchyma and adjacent organs.With increasing utilization of laparoscopic and robotic pancreatectomy, patients can now undergo either an open or minimally invasive surgery (MIS) procedure. Laparoscopic and robotic PD has gained interest due to comparable morbidity, mortality and oncologic outcomes versus open PD when performed in select patients (11-15). For DP, MIS approach has now become the standard of care due to its favorable outcomes in comparison to open DP (11,16). In a recent meta-analysis comparing 1,814 patients undergoing open versus laparoscopic DP, the laparoscopic approach resulted in less blood loss, shorter hospital length of stay (LOS), fewer surgical site infections and lower morbidity (17). Similarly, a MIS approach for CP has become increasingly common with the goal of decreasing the impact of morbidity related to the decreased size of incisions, shorter hospital stays, and shorter time until return to work. While both laparoscopic and robotic CP are being performed, laparoscopy may be somewhat limited giv...

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confidence: 71%

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

2016

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“…A large body of evidence has shown that minimally invasive surgery is superior to an open approach as it is associated with less postoperative pain, a shorter hospital stay, and equivalent oncological outcomes in malignant diseases [11]. During the last decade, minimally invasive pancreatic surgery has been slowly adopted in large tertiary centers for both benign and malignant pathologies [12]. …”

Section: Discussionmentioning

confidence: 99%

Robotic cystogastrostomy and debridement of walled-off pancreatic necrosis

2016

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Walled-off pancreatic necrosis is a known complication of acute pancreatitis and requires intervention if symptomatic or complicated. Laparoscopic cystogastrostomy as a minimally invasive surgical intervention has been well-described in surgical literature but data on a robotic approach is limited. Here we report a case of robotic cystogastrostomy and debridement of walled-off pancreatic necrosis in a patient with a history of severe biliary pancreatitis.

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“…When different series are reviewed, the most important advantage from the robotic technology that is strongly applied to pancreatic resections is the resemblance of open surgery that it offers to the surgeon [35]. When discussing its benefits during the performance of a Whipple procedure, on the other hand, the additional advantage of surgeon comfort provided by sitting at the console to control the master interface takes precedence.…”

Section: Hepatobiliary and Pancreatic Surgery: Nothing Is Impossiblementioning

confidence: 99%

The Surgical Robot: Applications and Advantages in General Surgery

Barrera¹

2018

Surgical Robotics

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The field of General Surgery with its multiple sub-specialties has experienced the progression of minimally invasive procedures performed with the robotic technology since the last decade. The robotic applications are extensive and have contributed to the enrichment of the surgical sub-specialties based on advantages such as increased surgeon control and autonomy, superior instrument dexterity and tissue handling, improved three-dimensional visualization, wristed articulation, all of this despite the lack of haptic feedback. The sub-specialties of Colorectal, Hepatobiliary and Pancreatic, Gastric Oncologic, Bariatric, Foregut, Pediatric, Endocrine, and Hernia Surgery, in addition to General Surgery as the principal specialty, have produced several high-quality randomized controlled trials, meta-analyses, prospective and retrospective series which have established, in many instances, superior results to those of laparoscopy, and at least non-inferior outcomes over the years. From the first pioneer single-surgeon experiences around the world to the most recent large trials, including the first Robotic General Surgery case series in an American community hospital not classified as a tertiary referral center, patients continue to benefit from this technology as surgeons engage in overcoming their learning curve and training their teams, involving their hospital administrators and working with the industry to perfect their techniques for the sake of their patients.

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The State of the Art of Robotic Pancreatectomy

Cited by 23 publications

References 33 publications

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

Robotic cystogastrostomy and debridement of walled-off pancreatic necrosis

The Surgical Robot: Applications and Advantages in General Surgery

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