Worldwide survey on opinions and use of minimally invasive pancreatic resection

Abstract

Background: Distal pancreatectomy with celiac artery resection (DPCAR) is in use for borderline-resectable pancreatic cancer. It is believed that considerable reduction of the liver arterial supply after DPCAR may cause severe liver ischemia. Although the artery reconstruction is not a problem anymore the decision to reconstruct artery has to be justified. To study liver collateral arterial supply after temporary CHA, right gastroepiploic and accessory/ replaced left hepatic arteries (a/rLHA). Methods: Arterial anatomy, diameters of CHA, proper hepatic (PHA), gastroduodenal(GDA) and pancreatoduodenal arteries(PDA) were registered before surgery in 110 consecutive patients with pancreatic body/tail cancer(n35), gastric cancer with pancreatic involvementn30) and liver tumors(n45)by CT. For DPCAR(n20) these data were obtained after surgery as well. Diameters of peripancreatic arteries and mean systolic blood velocity in hepatic arteries before and after CHA clamping were measured intraoperatively by Doppler ultrasound. Results: Pulse disappeared in 19 (17 %) cases after clamping of CHA,RGEA and aLHA/rLPA. Collateral arterial blood flow in the liver parenchyma was revealed in all cases. DPCAR led to increase of GDA, rRHA, PDA and RGEA blood flow in 0,9-12 times. Conclusion: Doppler ultrasound is a reliable modality for intraoperative assessment of liver arterial blood supply after DPCAR; Hepatic artery reconstruction may be necessary after DPCAR in case of disappearance of arterial US signal upon the liver parenchyma.

Robotic-Assisted versus Laparoscopic Distal Pancreatectomy: The Results of a Case-Matched Analysis from a Tertiary Care Center

“…Finally, a lack of specific training was cited as the most common reason for not performing a minimally invasive approach [21]. These confirmed the findings of a pan-European survey during which, 45% of surgeons stated they had insufficient training in LDP [22], although 73% of surgeons had experience with minimally invasive distal pancreatectomy [22].…”

“…In various studies, it has demonstrated superiority over the open approach in terms of less blood loss, faster recovery, shorter hospital stays, and lower positive margin rate, with comparable morbidity and mortality [18], nodal assessment [19], overall survival, and lower total costs [20]. Unfortunately, LDP has not reached a uniform acceptance among HPB surgeons [21].…”

“…The first international survey on Minimally Invasive Pancreatic Resection, which included 435 surgeons, concluded that 345 out 435 (79%) reported performing minimally invasive distal pancreatectomy, but the minimally invasive distal pancreatectomy median lifetime case volume was quite low (around 20) [21].…”

Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

“…Recently, the multicentre randomized LEOPARD trial showed a 2‐day reduction in time to functional recovery and duration of hospital stay in favour of minimally invasive distal pancreatectomy compared with the open approach. Despite these positive results, the costs associated with minimally invasive surgery could be a barrier to further implementation.…”

Formal robotic training diminishes the learning curve for robotic pancreatoduodenectomy: Implications for new programs in complex robotic surgery

“…These findings highlight the necessity of formal robotic training programs in pancreatic surgery to ensure safe implementation. Additionally, these data are critically important to facilitate dissemination of the robotic approach, as pancreatic surgeons are eager to participate in formal training if the learning curve is surmountable 24 …”