Reduced port minimally invasive distal pancreatectomy: single-port laparoscopic versus robotic single-site plus one-port distal pancreatectomy
- 30 Downloads
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.
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.
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.
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.
KeywordsSingle port Laparoscopic Robotic Distal pancreatectomy
Compliance with ethical standards
Drs. Hyung Joon Han and Chang Moo Kang have no conflict of interest or financial ties to disclose.
- 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
- 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.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.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
- 18.Kang CM (2018) Robotic single-site plus ONE-port distal pancreatectomy. Ann Pancreat Cancer 1Google Scholar
- 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.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
- 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
- 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
- 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.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