Advertisement

Reduced port minimally invasive distal pancreatectomy: single-port laparoscopic versus robotic single-site plus one-port distal pancreatectomy

  • Hyung Joon Han
  • Chang Moo Kang
Article
  • 30 Downloads

Abstract

Background

Minimally invasive surgery appears to be developing in multiple directions, including single-port laparoscopic (SPL), single-port robotic, reduced port laparoscopic, or single-site plus one-port robotic approach. The aim of study was to compare the short-term perioperative variables and outcomes of patients undergoing reduced port minimally invasive distal pancreatectomy (DP) via the SPL, or robotic single-site plus one-port (RSS + 1) approach.

Methods

The medical records of 35 patients were retrospectively reviewed, who underwent SPL-DP (n = 22) or RSS + 1 DP (n = 13) at Korea University Ansan Hospital and Yonsei University Severance Hospital.

Results

The mean operation time in SPL group was significantly higher than that of RSS + 1 group (281 vs 192, p = .001). The mean blood loss in SPL was significantly larger than that of RSS + 1 group (163 vs 12, p = .002). The mean length of free resection margin in SPL group was significantly longer than that of RSS + 1 group (2.1 vs 0.4 cm, p = .001). Spleen was significantly preserved in SPL group (54.5 vs 7.7%, p = .001). All RSS + 1 cases had tumors located near spleen hilum (p < .001). SPL approach had significantly grade IIIa complications (p = .014). Moreover, the mean hospital stay in SPL group was significantly longer than that of RSS + 1 group (14.4 vs 7.4 days, p = .004). Postoperative pancreatic fistula (POPF) was significantly observed in longer operation time (p = .043) and smaller tumor size (p = .037) in the univariate analysis. Higher BMI was significantly important factor for prolonged operation time (p = .034) in the multivariate analysis. Prolonged hospital stay was related to spleen preservation (p = .014) in the multivariate analysis.

Conclusions

Both SPL and RSS + 1 are technically feasible and safe. RSS + 1-DP is superior to SPL-DP in terms of operation time, blood loss, severe complications, and hospital stay. SPL-DP shows advantages in terms of single wound site, less trocar usage, higher rate of spleen preservation, and wider range of operative field.

Keywords

Single port Laparoscopic Robotic Distal pancreatectomy 

Notes

Compliance with ethical standards

Disclosure

Drs. Hyung Joon Han and Chang Moo Kang have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Jusoh AC, Ammori BJ (2012) Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 26:904–913.  https://doi.org/10.1007/s00464-011-2016-3 CrossRefPubMedGoogle Scholar
  2. 2.
    Benzing C, Krenzien F, Atanasov G, Seehofer D, Sucher R, Zorron R, Pratschke J, Schmelzle M (2015) Single incision laparoscopic liver resection (SILL)—a systematic review. GMS Interdisc Plast Reconstr Surg DGPW 4:Doc17.  https://doi.org/10.3205/iprs000076 Google Scholar
  3. 3.
    Kang BM, Kim HJ, Kye BH, Lee SC, Lee KY, Park SJ, Lee SH, Lim SW, Lee YS, Kim JH, Lee J, Kim MK, Kim JG (2018) Multicenter, randomized single-port versus multiport laparoscopic surgery (SIMPLE) trial in colon cancer: an interim analysis. Surg Endosc 32:1540–1549.  https://doi.org/10.1007/s00464-017-5842-0 CrossRefPubMedGoogle Scholar
  4. 4.
    Lee Y, Kim HH (2017) Single-incision Laparoscopic gastrectomy for gastric cancer. J Gastric Cancer 17:193–203.  https://doi.org/10.5230/jgc.2017.17.e29 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Autorino R, Kaouk JH, Stolzenburg JU, Gill IS, Mottrie A, Tewari A, Cadeddu JA (2013) Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol 63:266–280.  https://doi.org/10.1016/j.eururo.2012.08.028 CrossRefPubMedGoogle Scholar
  6. 6.
    Inaki N, Tsuji T, Doden K, Sakimura Y, Tawara H, Matsui R, Yamamoto D, Kitamura H, Bando H, Yamada T (2016) Reduced port laparoscopic gastrectomy for gastric cancer. Transl Gastroenterol Hepatol 1:38.  https://doi.org/10.21037/tgh.2016.04.04 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bae SU, Jeong WK, Baek SK (2017) Reduced-port robotic total mesorectal resection for rectal cancer using a single-port access: a technical note. Wideochir Inne Tech Maloinwazyjne 12:378–384.  https://doi.org/10.5114/wiitm.2017.69727 PubMedPubMedCentralGoogle Scholar
  8. 8.
    Cuschieri A (1994) Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 39:178–184PubMedGoogle Scholar
  9. 9.
    Melvin WS, Needleman BJ, Krause KR, Ellison EC (2003) Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A 13:33–36.  https://doi.org/10.1089/109264203321235449 CrossRefPubMedGoogle Scholar
  10. 10.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784.  https://doi.org/10.1001/archsurg.138.7.777 CrossRefPubMedGoogle Scholar
  11. 11.
    Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 257:128–132.  https://doi.org/10.1097/SLA.0b013e31825fff08 CrossRefPubMedGoogle Scholar
  12. 12.
    Souche R, Herrero A, Bourel G, Chauvat J, Pirlet I, Guillon F, Nocca D, Borie F, Mercier G, Fabre JM (2018) Robotic versus laparoscopic distal pancreatectomy: a French prospective single-center experience and cost-effectiveness analysis. Surg Endosc.  https://doi.org/10.1007/s00464-018-6080-9 Google Scholar
  13. 13.
    Barbaros U, Sumer A, Demirel T, Karakullukcu N, Batman B, Icscan Y, Saricam G, Serin K, Loh WL, Dinccag A, Mercan S (2010) Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma. JSLS 14:566–570.  https://doi.org/10.4293/108680810x12924466008448 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Han HJ, Yoon SY, Song TJ, Choi SB, Kim WB, Choi SY, Park SH (2014) Single-port laparoscopic distal pancreatectomy: initial experience. J Laparoendosc Adv Surg Tech A 24:858–863.  https://doi.org/10.1089/lap.2014.0151 CrossRefPubMedGoogle Scholar
  15. 15.
    Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363:701–704CrossRefPubMedGoogle Scholar
  16. 16.
    Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657.  https://doi.org/10.1007/s00464-009-0825-4 CrossRefPubMedGoogle Scholar
  17. 17.
    Goh BK, Chan CY, Soh HL, Lee SY, Cheow PC, Chow PK, Ooi LL, Chung AY (2017) A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot.  https://doi.org/10.1002/rcs.1733 PubMedGoogle Scholar
  18. 18.
    Kang CM (2018) Robotic single-site plus ONE-port distal pancreatectomy. Ann Pancreat Cancer 1Google Scholar
  19. 19.
    Kim SH, Kang CM, Lee WJ (2017) Robotic single-site plus ONE port distal pancreatectomy. Surg Endosc 31:4258–4259.  https://doi.org/10.1007/s00464-017-5476-2 CrossRefPubMedGoogle Scholar
  20. 20.
    Peng CM, Liu HC, Hsieh CL, Yang YK, Cheng TC, Chou RH, Liu YJ (2018) Application of a commercial single-port device for robotic single-incision distal pancreatectomy: initial experience. Surg Today.  https://doi.org/10.1007/s00595-018-1647-6 PubMedGoogle Scholar
  21. 21.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591.  https://doi.org/10.1016/j.surg.2016.11.014 CrossRefPubMedGoogle Scholar
  22. 22.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213.  https://doi.org/10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7.  https://doi.org/10.1097/SLA.0b013e318296c732 CrossRefPubMedGoogle Scholar
  24. 24.
    Kremer E, Atkinson JH, Ignelzi RJ (1981) Measurement of pain: patient preference does not confound pain measurement. Pain 10:241–248CrossRefPubMedGoogle Scholar
  25. 25.
    Cleary SP, Han HS, Yamamoto M, Wakabayashi G, Asbun HJ (2016) The comparative costs of laparoscopic and open liver resection: a report for the 2nd International Consensus Conference on Laparoscopic Liver Resection. Surg Endosc 30:4691–4696.  https://doi.org/10.1007/s00464-016-4801-5 CrossRefPubMedGoogle Scholar
  26. 26.
    Fong Y, Woo Y, Giulianotti PC (2017) Robotic surgery: the promise and finally the progress. Hepatobiliary Surg Nutr 6:219–221.  https://doi.org/10.21037/hbsn.2017.04.04 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Chen S, Zhan Q, Chen JZ, Jin JB, Deng XX, Chen H, Shen BY, Peng CH, Li HW (2015) Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc 29:3507–3518.  https://doi.org/10.1007/s00464-015-4101-5 CrossRefPubMedGoogle Scholar
  28. 28.
    Guerrini GP, Lauretta A, Belluco C, Olivieri M, Forlin M, Basso S, Breda B, Bertola G, Di Benedetto F (2017) Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg 17:105.  https://doi.org/10.1186/s12893-017-0301-3 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC 2nd, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446.  https://doi.org/10.1097/SLA.0b013e318185a990 PubMedGoogle Scholar
  30. 30.
    de Rooij T, Cipriani F, Rawashdeh M, van Dieren S, Barbaro S, Abuawwad M, van Hilst J, Fontana M, Besselink MG, Abu Hilal M (2017) Single-surgeon learning curve in 111 laparoscopic distal pancreatectomies: does operative time tell the whole story? J Am Coll Surg 224:826–832.e821.  https://doi.org/10.1016/j.jamcollsurg.2017.01.023 CrossRefPubMedGoogle Scholar
  31. 31.
    Kang CM (2015) Is robot-assisted minimally invasive distal pancreatectomy superior to the laparoscopic technique? Ann Surg 261:e153–e154.  https://doi.org/10.1097/sla.0000000000000682 CrossRefPubMedGoogle Scholar
  32. 32.
    Gavriilidis P, Lim C, Menahem B, Lahat E, Salloum C, Azoulay D (2016) Robotic versus laparoscopic distal pancreatectomy—the first meta-analysis. HPB 18:567–574.  https://doi.org/10.1016/j.hpb.2016.04.008 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Zhou J-Y, Xin C, Mou Y-P, Xu X-W, Zhang M-Z, Zhou Y-C, Lu C, Chen R-G (2016) Robotic versus laparoscopic distal pancreatectomy: a meta-analysis of short-term outcomes. PLoS ONE 11:e0151189CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea
  2. 2.Division of Hepatobiliopancreas and Transplant SurgeryKorea University Ansan HospitalAnsan-siRepublic of Korea
  3. 3.Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  4. 4.Yonsei Pancreatobiliary Cancer CenterSeverance HospitalSeoulRepublic of Korea

Personalised recommendations