What role does hand-assistance have in minimally invasive pancreatic surgery?

Abstract

Surgery poses an important stress on the patient from both physical and psychological points of view per se. It has become clearer with time that, regardless of the type of surgical operation, a smaller surgical incision could reduce the operation-induced stress. With advancements in technology, great efforts have been made in trying to reduce this burden on the patient, leading to the development of minimally invasive surgery (MIS) [1,2] . MIS has gained increasing support since its introduction and has undergone continuous improvements and evolutions to the point of becoming, nowadays, the standard of care for many surgical procedures such as cholecystectomy, adrenalectomy, splenectomy, and fundoplication. MIS encompasses several different approaches which have in common the aim of decreasing the impact of the surgical operation on the patient. The first approach to be developed and widely accepted in clinical practice was laparoscopy. Among the well-established advantages of laparoscopic surgery, we have decreased pain, shorter length of stay, faster postoperative recovery, and a better visualization of secluded anatomical spaces which would otherwise require a large incision to be correctly exposed [3] . All of this comes at the price of decreased dexterity, diminished tactile feedback, and inherent limitations posed by restricted degrees of freedom of laparoscopic instrumentation, which may result in a longer operative time compared to the open approach for complex surgical procedures [4] . In recent years, an alternative to the laparoscopic technique has been proposed with the introduction of robotic platforms in surgery. Potential advantages of robotic surgery are filtration of tremors, better dexterity, higher degrees of freedom with the EndoWrist system, and better Not applicable.

Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery

“…HALDP could be used as an alternative option to convert from the total laparoscopic approach in cases where dissection is difficult, unclear anatomy or the risk of hemorrhage is high. It may also be used in cases of malignancy, where HALDP facilitates palpation of tumor and staging and can facilitate dissection for voluminous lesions [ 24 ]. Future research should consider separately analyzing patients who underwent hand-assisted distal pancreatectomy from those who had total laparoscopic distal pancreatectomy as they may confer different outcomes.…”

Keeping surgeons in the loop: are handheld robotics the best path towards more autonomous actions? (A comparison of complete vs. handheld robotic hepatectomy for colorectal liver metastases)

“…Conversely, this technology could also be preventing the stapling of tissue that is too thin, similarly decreasing the risk of intraoperative and postoperative complications. In a recent animal study, powered stapled anastomoses were found to have a higher burst pressure when compared to conventional stapling techniques [32,33,41] . On the surface, these advantages may appear to be minor benefits; nonetheless, our data clearly show that a potential benefit to HR liver resection in increasing the number of resections that can be done MI may exist, and this at least warrants further exploration.…”