Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy - A comparative study

Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China.
International Journal of Surgery (London, England) (Impact Factor: 1.65). 06/2012; 10(9). DOI: 10.1016/j.ijsu.2012.06.003
Source: PubMed

ABSTRACT BACKGROUND: Traditionally, pancreatic surgery is considered as one of the most complex surgeries. The recently developed robotic technology allows surgeons to perform pancreaticoduodenectomy. A comparative study was undertaken to study outcomes between robotic approach and open approach. METHODS: A consecutive patients underwent pancreaticoduodenectomy (robotic approach, n = 20; open approach = 67) between January 2000 and February 2012 at a single institution were analyzed. RESULTS: The robotic group had a significantly longer operative time (mean, 491.5 vs. 264.9 min), reduced blood loss (mean, 247 vs. 774.8 ml), and shorter hospital stay (mean, 13.7 vs. 25.8 days) compared to the open group. Open conversion rate was 5%. There was no significant difference between the two groups in terms of overall complication rates, mortality rates, R0 resection rate and harvested lymph node numbers. CONCLUSIONS: This study showed that robot-assisted laparoscopic pancreaticoduodenectomy was safe and feasible in appropriately selected patients. However, it is too early to draw definitive conclusions about the value of robot-assisted laparoscopic pancreaticoduodenectomy. In light of remaining uncertainties regarding short-term and long-term outcome, caution should be exercised in the assessment of the appropriateness of this operation for individual patient.

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    ABSTRACT: Pancreatoduodenectomy remains one of the most complex and technically challenging procedures of the upper gastrointestinal tract with a mortality rate of 5 % and morbidity of 40 %. In an attempt to refine the Whipple procedure and taking into consideration the success of minimally invasive surgery in other organ systems, some have popularized the laparoscopic pancreatoduodenectomy (LPD). However, laparoscopic surgery carries several limitations that can make the LPD difficult to implement. Use of the robotic platform offers multiple advantages that may allow robotic assisted pancreatoduodenctomy to be readily adopted. As the robotic platform becomes increasingly popular, this report will provide an up to date review on the robotic pancreatoduodenectomy.
    06/2013; 1(2). DOI:10.1007/s40137-013-0017-y
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    ABSTRACT: BACKGROUND: Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. METHODS: As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. RESULTS: Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. CONCLUSION: Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short- and long-term outcomes seem to be similar to the ones achieved in open surgery.
    Journal of Hepato-Biliary-Pancreatic Sciences 04/2013; 20(6). DOI:10.1007/s00534-013-0615-1 · 2.31 Impact Factor
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    ABSTRACT: BACKGROUND: This article reviews the current status of robot-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy. METHOD: Searches of MEDLINE and PubMed databases were conducted using the keywords "laparoscopic pancreatectomy," "robotic surgery," "pancreaticoduodenectomy" and "distal pancreatectomy" to find articles published between January 1990 and September 2012. Additional papers were identified by a manual search of the references in key articles. RESULTS: Only cases reports, cohort series and nonrandomized comparative studies were available to validate the outcomes of robotic pancreaticoduodenectomy and distal pancreatectomy. There was no randomized controlled trial comparing the robotic approach to the laparoscopic or open approach. To the best of our knowledge, only four studies have compared the robotic approach and the open approach for pancreaticoduodenectomy, and four studies have been published comparing the robotic approach and the laparoscopic approach for distal pancreatectomy. The data were difficult to interpret because of the heterogeneity of the pathologies and techniques used. Robotic-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy for appropriately selected patients can be performed safely, with postoperative complication rates and mortality rate comparable to results observed with laparoscopic or open techniques. Robotic surgical systems also seem to improve the spleen-preservation rate in distal pancreatectomy. The oncologic outcomes have not yet been adequately evaluated. CONCLUSIONS: Robotic pancreaticoduodenectomy and distal pancreatectomy are safe and feasible in appropriately selected patients. However, because of uncertainties regarding long-term oncologic outcome, caution should be exercised in assessing the appropriateness of this operation for individual patients. Further randomized and controlled studies are required to support the routine use of the robotic technology for pancreatectomy.
    Asian Journal of Endoscopic Surgery 05/2013; 6(3). DOI:10.1111/ases.12040