Transition from open to robotic distal pancreatectomy in a low volume pancreatic surgery country: a single Australian centre experience

Abstract

Background Advances in technology and techniques have allowed for robotic distal pancreatectomies to be readily performed in patients at high volume centres. This study describes the experience of a single surgeon during the learning curve and transition from open to robotic distal pancreatectomy in Australia, a traditionally low volume pancreatic surgery country. Methods All patients undergoing distal pancreatectomy at an Australian‐based tertiary referral centre between 2010 and 2021 were reviewed retrospectively. Demographic, clinicopathologic and survival data were analysed to compare perioperative and oncological outcomes between patients who underwent open, laparoscopic and robotic distal pancreatectomies. Results A total of 178 distal pancreatectomies were identified for analysis during the study period. Ninety‐one open distal pancreatectomies (ODP), 48 laparoscopic distal pancreatectomies (LDP), and 39 robotic distal pancreatectomies (RDP) were performed. Robotic distal pancreatectomy was non‐inferior with respect to perioperative outcomes and yielded statistically non‐significant advantages over LDP and ODP. Conclusion RDP is feasible and can be performed safely in well‐selected patients during the learning phase at large pancreatic centres in a traditionally low‐volume country like Australia. Referral to large pancreatic centres where access to the robotic platform and surgeon experience is not a barrier, and where a robust multidisciplinary team meeting can take place, remains pivotal in the introduction and transition toward the robotic approach for management of patients with pancreatic body or tail lesions.

Spleen-preserving distal pancreatectomy from multi-port to reduced-port surgery approach

“…To the best of our knowledge, this is the first review to summarize all of the available data on patients who underwent spleen-preserving DP using reduced-port robotic or reduced-port laparoscopic approaches. All other published review papers have focused on comparing the advantages and disadvantages of multi-port RDP vs multi-port LDP[ 10 - 13 , 24 - 27 ]. However, the relative value of reduced-port LDP and reduced-port RDP has not been fully reviewed.…”