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Robotic pancreatoduodenectomy: trends in technique and training challenges

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Abstract

Background

More complex cases are being performed robotically. This study aims to characterize trends in robotic pancreatoduodenectomy (RPD) over time and assess opportunities for advanced trainees.

Methods

Using the ACS-NSQIP database from 2014 to 2019, PD cases were characterized by operative approach (open-OPN, laparoscopic-LAP, robotic-ROB). Proficiency and postoperative outcomes were described by approach over time.

Results

24,268 PDs were identified, with the ROB approach increasing from 2.8% to 7.5%. Unplanned conversion increased over time for LAP (27.7–39.0%, p = 0.003) but was unchanged for ROB cases (14.8–14.7%, p = 0.257). Morbidity increased for OPN PD (35.5–36.8%, p = 0.041) and decreased for ROB PD (38.7–30.3%, p = 0.010). Mean LOS was lower in ROB than LAP/OPN (9.5 vs. 10.9 vs. 10.9 days, p < 0.00001). Approximately, 100 AHPBA, SSO, and ASTS fellows are being trained each year in North America; however, only about 5 RPDs are available per trainee per year which is far below that recommended to achieve proficiency.

Conclusion

Over a 6-year period, a significant increase was observed in the use of RPD without a concomitant increase in conversion rates. RPD was associated with decreased morbidity and length of stay. Despite this shift, the number of cases being performed is not adequate for all fellows to achieve proficiency before graduation.

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Data availability

The data that support the findings of this study are available from the American College of Surgeons. Restrictions apply to the availability of these data, which were used under license for this study. Data are available for request at https://www.facs.org/quality-programs/acs-nsqip/participant-use/puf-form with the permission of the American College of Surgeons.

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Funding

This study was not funded by an outside source.

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Authors and Affiliations

  1. Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA

    Catherine H. Davis, Miral S. Grandhi, Victor P. Gazivoda, Alissa Greenbaum, Timothy J. Kennedy, Russell C. Langan, H. Richard Alexander, Henry A. Pitt & David A. August

  2. Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA

    Catherine H. Davis, Miral S. Grandhi, Victor P. Gazivoda, Alissa Greenbaum, Timothy J. Kennedy, Russell C. Langan, H. Richard Alexander, Henry A. Pitt & David A. August

  3. Department of Surgery, Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, NJ, USA

    Russell C. Langan

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  1. Catherine H. Davis
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Correspondence to David A. August.

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Drs. Catherine Davis, Miral Grandhi, Victor Gazivoda, Alissa Greenbaum, Timothy Kennedy, Russell Langan, H. Richard Alexander, Henry Pitt, and David August have no disclosures.

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Davis, C.H., Grandhi, M.S., Gazivoda, V.P. et al. Robotic pancreatoduodenectomy: trends in technique and training challenges. Surg Endosc 37, 266–273 (2023). https://doi.org/10.1007/s00464-022-09469-3

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