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: 1.53). 06/2012; 10(9). DOI: 10.1016/j.ijsu.2012.06.003
Source: PubMed


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.

A consecutive patients underwent pancreaticoduodenectomy (robotic approach, n=20; open approach=67) between January 2000 and February 2012 at a single institution were analyzed.

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.

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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    • "However to date, no prospective randomized trial has been performed comparing the open with the laparoscopic or robotic procedure. Currently, only 4 nonrandomized studies compared the outcome of open and robotic PD [15, 17, 18, 20]. The operation time was significantly shorter in the open procedure in three and robotic in one of these studies. "
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    ABSTRACT: During the last decades an increasing number of minimally invasive pancreatic resections have been reported in the literature. With the development of robotic surgery a new enthusiasm has not only increased the number of centers approaching minimally invasive pancreatic surgery in general but also enabled the use of this technique for major pancreatic procedures, in particular in minimally invasive pancreatoduodenectomy. The aim of this review was to define the state of the art of pancreatic robotic surgery. No prospective randomized trials have been performed comparing robotic, laparoscopic, and open pancreatic procedures. From the literature one may conclude that robotic pancreatectomies seem to be as feasible and safe as open procedures. The general idea that the overall perioperative costs of robotic surgery would be higher than traditional procedures is not supported. With the current lack of evidence of any oncologic advantages, the cosmetic benefits offered by robotic surgery are not enough to justify extensive use in cancer patients. In contrast, the safety of these procedure can justify the use of the robotic technique in patient with benign/low grade malignant tumors of the pancreas.
    BioMed Research International 05/2014; 2014:920492. DOI:10.1155/2014/920492 · 3.17 Impact Factor
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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 · 2.99 Impact Factor
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