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Total robotic pancreaticoduodenectomy: a systematic review of the literature

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Abstract

Background

Pancreaticoduodenectomy (PD) is a complex operation with high perioperative morbidity and mortality, even in the highest volume centers. Since the development of the robotic platform, the number of reports on robotic-assisted pancreatic surgery has been on the rise. This article reviews the current state of completely robotic PD.

Materials and Methods

A systematic literature search was performed including studies published between January 2000 and July 2016 reporting PDs in which all procedural steps (dissection, resection and reconstruction) were performed robotically.

Results

Thirteen studies met the inclusion criteria, including a total of 738 patients. Data regarding perioperative outcomes such as operative time, blood loss, mortality, morbidity, conversion and oncologic outcomes were analyzed. No major differences were observed in mortality, morbidity and oncologic parameters, between robotic and non-robotic approaches. However, operative time was longer in robotic PD, whereas the estimated blood loss was lower. The conversion rate to laparotomy was 6.5–7.8%.

Conclusions

Robotic PD is feasible and safe in high-volume institutions, where surgeons are experienced and medical staff are appropriately trained. Randomized controlled trials are required to further investigate outcomes of robotic PD. Additionally, cost analysis and data on long-term oncologic outcomes are needed to evaluate cost-effectiveness of the robotic approach in comparison with the open technique.

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Authors and Affiliations

  1. 1st Department of Surgery, “G. Genimatas” General Hospital, Athens, Greece

    Michail Kornaropoulos, Marinos C. Makris & Apostolos Mitrousias

  2. Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE60, Cleveland, OH, 44195, USA

    Demetrios Moris

  3. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA

    Eliza W. Beal

  4. Hepatobiliary and Surgical Oncology Department, Nicosia Teaching Hospital, Nicosia, Cyprus

    Athanasios Petrou

  5. 1st Department of Surgery, Laikon General Hospital, Athens, Greece

    Evangelos Felekouras, Adamantios Michalinos, Michail Vailas, Dimitrios Schizas & Alexandros Papalampros

Authors
  1. Michail Kornaropoulos
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  2. Demetrios Moris
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  3. Eliza W. Beal
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  4. Marinos C. Makris
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Contributions

Author contributions

MK, MV, AP contributed to study concept and design. MK, DM, DS helped with acquisition of data. MK, DM, AP, AM contributed to analysis and interpretation of data. DM, EF, AP helped in drafting of the manuscript. DM, AMitrousias, AMichalinos, EF contributed to critical revision of the manuscript for important intellectual content. EWB helped in editing and Linguistic control. MK, DM contributed to statistical analysis. MV helped with administrative, technical or material support. EWB, MCM helped with revision. AP contributed to supervision.

Corresponding author

Correspondence to Demetrios Moris.

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Drs. Michail Kornaropoulos, Demetrios Moris, Eliza W. Beal, Marinos C. Makris, Apostolos Mitrousias, Athanasios Petrou, Evangelos Felekouras, Adamantios Michalinos, Michail Vailas, Dimitrios Schizas and Alexandros Papalampros have no conflicts of interest or financial ties to disclose.

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Kornaropoulos, M., Moris, D., Beal, E.W. et al. Total robotic pancreaticoduodenectomy: a systematic review of the literature. Surg Endosc 31, 4382–4392 (2017). https://doi.org/10.1007/s00464-017-5523-z

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