Updates in Surgery

, Volume 71, Issue 1, pp 137–144 | Cite as

Robotic versus standard open pancreatectomy: a propensity score-matched analysis comparison

  • Benedetto IelpoEmail author
  • Riccardo Caruso
  • Hipolito Duran
  • Eduardo Diaz
  • Isabel Fabra
  • Luis Malavé
  • Yolanda Quijano
  • Emilio Vicente
Original Article


Interest in robotic pancreatectomy has been greatly increasing over the last decade. However, evidence supporting the benefits of robotic over open pancreatectomy is still outstanding. This study aims to assess the safety and efficacy of robotic pancreatectomy compared with the conventional open surgical approach. Propensity score-matched (1:1) was used to balance age, sex, BMI, ASA, tumor size, and malignancy of 17 robotic pancreaticoduodenectomies (PD), 12 pancreatic enucleations (PE), and 28 distal pancreatectomies (DP); and was compared with the open standard approach. Robotic PD was associated with longer operative time (594 vs. 413 min; p = 0.03) and decreased blood loss (190 vs. 394 ml; p = 0.001). Robotic PE showed a lower mean length of hospital stay (8.4 vs. 12.8 days; p = 0.04) and, in addition, robotic DP showed less blood loss (175 vs. 375 ml; p = 0.01), less severe morbidities (7.14 vs. 17.9%; p = 0.02), and a reduced mean length of hospital stay (8.9 vs. 15.1; p = 0.001). Overall, conversion rate was 4 (7%). Robotic pancreatectomy is as safe and effective as the standard open surgical approach with reduced blood loss in PD and DP, length of hospital stay in PE and DP, and severe morbidity in DP.


Pancreatic resection Robotic surgery Case matched 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The study was approved by the institutional ethical committee of the HM Hospitals group.

Informed consent

All patients included were informed about the treatment and written informed consent was obtained before all surgeries.

Supplementary material

Supplementary material 1 (MP4 94342 kb)


  1. 1.
    Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ et al (2007) Post pancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25CrossRefGoogle Scholar
  2. 2.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefGoogle Scholar
  3. 3.
    Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Maeda H, Yatabe T et al (2009) Continuous post- operative blood glucose monitoring and control by artificial pancreas in patients having pancreatic resection: a prospective randomized clinical trial. Arch Surg 144:933–937CrossRefGoogle Scholar
  4. 4.
    Edge SB, Fritz AG, Byrd DR (eds) (2010) AJCC cancer staging manual handbook, 7th edn. Springer, New YorkGoogle Scholar
  5. 5.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  6. 6.
    Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRefGoogle Scholar
  7. 7.
    Nishino M, Jackman DM, Hatabu H, Yeap BY, Cioffredi LA, Yap JT et al (2010) New Response Evaluation Criteria in Solid Tumors (RECIST) Guidelines for Advanced Non-Small Cell Lung Cancer: comparison with original RECIST and impact on assessment of tumor response to targeted therapy. AJR Am J Roentgenol 195(3):W221–W228CrossRefGoogle Scholar
  8. 8.
    Memeo R, Sangiuolo F, de Blasi V, Tzedakis S, Mutter D, Marescaux J et al (2016) Robotic pancreaticoduodenectomy and distal pancreatectomy: state of the art. J Visc Surg 153(5):353–359CrossRefGoogle Scholar
  9. 9.
    Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402CrossRefGoogle Scholar
  10. 10.
    Baker EH, Ross SW, Seshadri R, Swan RZ, Iannitti DA, Vrochides D et al (2015) Robotic pancreaticoduodenectomy for pancreatic adenocarcinoma: role in 2014 and beyond. J Gastrointest Oncol 6:396–405Google Scholar
  11. 11.
    Bao PQ, Mazirka PO, Watkins KT (2014) Retrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg 18:682–689CrossRefGoogle Scholar
  12. 12.
    Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC et al (2011) Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 35:2739–2746CrossRefGoogle Scholar
  13. 13.
    Chen S, Chen J-Z, Zhan Q, Deng XX, Shen BY, Peng CH et al (2015) Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29:3698–3711CrossRefGoogle Scholar
  14. 14.
    Lai EC, Tang CN (2015) Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes. Front Med 9(3):356–360CrossRefGoogle Scholar
  15. 15.
    Zhou NX, Chen JZ, Liu Q, Zhang X, Wang Z, Ren S et al (2011) Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Robot 7:131–137CrossRefGoogle Scholar
  16. 16.
    Zhang J, Wu WM, You L, Zhao YP (2013) Robotic versus open pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 20:1774–1780CrossRefGoogle Scholar
  17. 17.
    Napoli N, Kauffmann EF, Menonna F et al (2018) Robotic versus open pancreatoduodenectomy: a propensity score-matched analysis based on factors predictive of postoperative pancreatic fistula. Surg Endosc 32:1234–1247CrossRefGoogle Scholar
  18. 18.
    Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB et al (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446Google Scholar
  19. 19.
    Lee SY, Allen PJ, Sadot E, D’Angelica MI, DeMatteo RP, Fong Y et al (2015) Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg 220:18–27CrossRefGoogle Scholar
  20. 20.
    Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado MA, Navarro S (2007) Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 11:1607–1621CrossRefGoogle Scholar
  21. 21.
    Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW et al (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268CrossRefGoogle Scholar
  22. 22.
    Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657CrossRefGoogle Scholar
  23. 23.
    Duran H, Ielpo B, Caruso R, Ferri V, Quijano Y, Diaz E et al (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 10(3):280–285CrossRefGoogle Scholar
  24. 24.
    Napoli N, Kauffmann EF, Palmeri M et al (2016) The learning curve in robotic pancreaticoduodenectomy. Dig Surg 33(4):299–307CrossRefGoogle Scholar
  25. 25.
    Napoli N, Kauffmann EF, Menonna F, Perrone VG, Brozzetti S, Boggi U (2016) Indications, technique, and results of robotic pancreatoduodenectomy. Updates Surg 68(3):295–305CrossRefGoogle Scholar
  26. 26.
    Kauffmann EF, Napoli N, Menonna F et al (2016) Robotic pancreatoduodenectomy with vascular resection. Langenbecks Arch Surg 401:1111–1122CrossRefGoogle Scholar
  27. 27.
    Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y et al (2010) Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg 211:503–509CrossRefGoogle Scholar
  28. 28.
    Shi Y, Peng C, Shen B, Deng X, Jin J, Wu Z et al (2016) Pancreatic enucleation using the da Vinci robotic surgical system: a report of 26 cases. Int J Med Robot 12(4):751–757CrossRefGoogle Scholar
  29. 29.
    Tian F, Hong XF, Wu WM, Han XL, Wang MY, Cong L et al (2016) Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours. Br J Surg 103(10):1358–1364CrossRefGoogle Scholar
  30. 30.
    Røsok BI, de Rooij T, van Hilst J, Diener MK, Allen PJ, Vollmer CM et al (2017) Minimally invasive distal pancreatectomy. HPB (Oxford) 19(3):205–214CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Benedetto Ielpo
    • 1
    Email author
  • Riccardo Caruso
    • 1
  • Hipolito Duran
    • 1
  • Eduardo Diaz
    • 1
  • Isabel Fabra
    • 1
  • Luis Malavé
    • 1
  • Yolanda Quijano
    • 1
  • Emilio Vicente
    • 1
  1. 1.General Surgery Department, Sanchinarro University HospitalSan Pablo CEU University of MadridMadridSpain

Personalised recommendations