Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study
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The enhanced dexterity offered by robotic assistance could be excessive for distal pancreatectomy but not enough to improve the outcome of laparoscopic pancreaticoduodenectomy. Total pancreatectomy retains the challenges of uncinate process dissection and digestive reconstruction, but avoids the risk of pancreatic fistula, and could be a suitable operation to highlight the advantages of robotic assistance in pancreatic resections.
Eleven laparoscopic robot-assisted total pancreatectomies (LRATP) were compared to 11 case-matched open total pancreatectomies. All operations were performed by one surgeon during the same period of time. Robotic assistance was employed in half of the patients, based on robot availability at the time of surgery. Variables examined included age, sex, American Society of Anesthesiologists score, body mass index, estimated blood loss, need for blood transfusions, operative time, tumor type, tumor size, number of examined lymph nodes, margin status, post-operative complications, 90-day or in-hospital mortality, length of hospital stay, and readmission rate.
No LRATP was converted to conventional laparoscopy, hand-assisted laparoscopy or open surgery despite two patients (18.1 %) required vein resection and reconstruction. LRATP was associated with longer mean operative time (600 vs. 469 min; p = 0.014) but decreased mean blood loss (220 vs. 705; p = 0.004) than open surgery. Post-operative complications occurred in similar percentages after LRATP and open surgery. Complications occurring in most patients (5/7) after LRATP were of mild severity (Clavien-Dindo grade I and II). One patient required repeat laparoscopic surgery after LRATP, to drain a fluid collection not amenable to percutaneous catheter drainage. One further patient from the open group required repeat surgery because of bleeding. No patient had margin positive resection, and the mean number of examined lymph nodes was 45 after LRATP and 36 after open surgery.
LRATP is feasible in selected patients, but further experience is needed to draw final conclusions.
KeywordsTotal pancreatectomy Laparosocopy Robot Da Vinci
Ugo Boggi, Simona Palladino, Gabriele Massimetti, Fabio Vistoli, Fabio Caniglia, Nelide De Lio, Vittorio Perrone, Linda Barbarello, Mario Belluomini, Stefano Signori, Gabriella Amorese, and Franco Mosca have no conflicts of interest or financial ties to disclose.
- 14.Choi SH, Hwang HK, Kang CM, Yoon CI, Lee WJ (2012) Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surg Endosc 26:2072–2077CrossRefPubMedGoogle Scholar
- 30.Janot MS, Belyaev O, Kersting S, Chromik AM, Seelig MH, Sülberg D, Mittelkötter U, Uhl WH (2010). Indications and early outcomes for total pancreatectomy at a high-volume pancreas center. HPB Surg article ID 686702, 8 pagesGoogle Scholar
- 33.Amano H, Miura F, Toyota N, Wada K, Katoh K, Hayano K, Kadowaki S, Shibuya M, Maeno S, Eguchi T, Takada T, Asano T (2009) Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg 16:850–857CrossRefPubMedGoogle Scholar
- 38.Balzano G, Maffi P, Nano R, Zerbi A, Venturini M, Melzi R, Mercalli A, Magistretti P, Scavini M, Castoldi R, Carvello M, Braga M, Del Maschio A, Secchi A, Staudacher C, Piemonti L (2013) Extending indications for islet autotransplantation in pancreatic surgery. Ann Surg 258:210–218CrossRefPubMedGoogle Scholar
- 40.Marquez S, Marquez TT, Ikramuddin S, Kandaswamy R, Antanavicuis G, Freeman ML, Hering BJ, Sutherland DE (2010) Laparoscopic and da Vinci robot-assisted total pancreaticoduodenectomy and intraportal islet autotransplantation: case report of a definitive minimally invasive treatment of chronic pancreatitis. Pancreas 39:1109–1111CrossRefPubMedGoogle Scholar
- 45.Fink C, Diener MK, Bruckner T, Müller G, Paulsen L, Keller M, Büchler MW, Knebel P (2013) Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: study protocol for a randomized controlled trial (PEDUCAT trial). Trials 14:271CrossRefPubMedCentralPubMedGoogle Scholar
- 46.Duran H, Ielpo B, Caruso R, Ferri V, Quijano Y, Diaz E, Fabra I, Oliva C, Olivares S, Vicente E (2014) Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robot. doi: 10.1002/rcs.1569