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Surgical Endoscopy

, Volume 27, Issue 3, pp 774–781 | Cite as

Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application

  • Ho Kyoung Hwang
  • Chang Moo KangEmail author
  • Young Eun Chung
  • Kyung Ah Kim
  • Sung Hoon Choi
  • Woo Jung Lee
Article

Abstract

Background

Advanced and delicate laparoscopic techniques are usually required for safe and successful laparoscopic spleen-preserving distal pancreatectomy. The unique characteristics of robotic surgical system are thought to be useful for this minimally invasive procedure.

Methods

From September 2007 to May 2011, patients who underwent robot-assisted, spleen-preserving, distal pancreatectomy for benign and borderline malignant tumors of the pancreas were retrospectively reviewed. Perioperative clinicopathologic surgical outcomes were evaluated.

Results

Twenty-two patients were attempted for robot-assisted, spleen-preserving, distal pancreatectomy, and in 21 patients (95.5 %), the spleen was saved either by splenic vessels conservation (SVC; n = 17, 81 %) or by splenic vessels sacrifice (SVS; n = 4, 19 %). Seven patients were male and 15 were female with a mean age of 43.2 ± 15.2 years. Pathologic diagnosis included MCT in five patients, SCT in five, SPT in four, IPMT in three, NET in three, and other benign conditions in two. The mean operation time was 398.9 ± 166.3 min, but it gradually decreased as experiences were accumulated (Rsq = 0.223, p = 0.023). Intraoperative blood loss was 361.3 ± 360.1 ml, and intraoperative transfusion was required in four patients (18.1 %). A soft diet was given for 1.2 ± 0.4 days, and the length of hospital stay was 7.0 ± 2.4 days postoperatively. Clinically relevant pancreatic fistula was noted in two patients (9.1 %) but was successfully managed conservatively. Most patients (87.5 %) showed patency in conserved both splenic vessels, and only two patients (12.5 %) had partially or completely obliterated in splenic veins in the SVC-SpDP group. Partially impaired splenic perfusion was observed in one patient in the SVS-SpDP group. The perfusion defect area decreased without any clinical symptom after 4 months.

Conclusions

The robotic surgical system is thought to be beneficial for improving the spleen-preservation rate in laparoscopic distal pancreatectomy. Robot-assisted approach can be chosen for patients who require spleen-preserving distal pancreatectomy.

Keywords

Robotic Spleen-preserving Distal pancreatectomy 

Notes

Disclosures

Drs. Ho Kyoung Hwang, Chang Moo Kang, Young Eun Chung, Kyung Ah Kim, Sung Hoon Choi, and Woo Jung Lee have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ho Kyoung Hwang
    • 1
    • 3
  • Chang Moo Kang
    • 1
    • 3
    Email author
  • Young Eun Chung
    • 2
    • 3
  • Kyung Ah Kim
    • 2
    • 3
  • Sung Hoon Choi
    • 1
    • 3
  • Woo Jung Lee
    • 1
    • 3
  1. 1.Division of Hepatobiliary and Pancreas, Department of SurgeryYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of RadiologyYonsei University College of MedicineSeoulSouth Korea
  3. 3.Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance HospitalYonsei University Health SystemSeoulSouth Korea

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