Skip to main content
SpringerLink
Log in

Development of Minimally Invasive Pancreatic Surgery: an Evidence-Based Systematic Review of Laparoscopic Versus Robotic Approaches

  • Evidence-Based Current Surgical Practice
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Laparoscopic and robotic surgery of the pancreas has only recently emerged as viable treatment options for benign and malignant disease. This review seeks to evaluate the current body of evidence on these approaches to pancreaticoduodenectomy and distal pancreatectomy.

Methods

A systematic review of large published series was performed utilizing the PubMed search engine.

Results

Based on these reports, both the laparoscopic and robotic techniques for these complex procedures appear to be safe and effective, if performed by high volume experienced pancreatic surgeons. The advantages of each approach are highlighted, emphasizing the data available on the learning curve and potential dissemination.

Conclusions

Both minimally invasive approaches to pancreatic resection are safe and feasible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Antoniou SA, Antoniou GA, Antoniou AI, Granderath FA. Past, present, and future of minimally invasive abdominal surgery. JSLS 2015;19:e2015.00052.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reyonlds Jr W. The first laparoscopic cholecystectomy. JSLS 2001;5:89-94.

    Google Scholar 

  3. Litynski GS. Mouret, Dubois, and Perissat: The laparoscopic breakthrough in Europe (1987–1988). JSLS 1999;3:163-167.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994;8:408-410.

    Article  CAS  PubMed  Google Scholar 

  5. Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 1994;39:178-184.

    CAS  PubMed  Google Scholar 

  6. Melvin WS, Needleman BJ, Krause KR, Ellison EC. Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A 2003;13:33-36.

    Article  CAS  PubMed  Google Scholar 

  7. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G. Robotics in general surgery: Personal experience in a large community hospital. Arch Surg 2003;138:777-784.

    Article  PubMed  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J, Altman DG for the PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.

    PubMed  Google Scholar 

  9. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: Overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 2012;215:810-819.

    Article  PubMed  Google Scholar 

  10. Kim SC, Song KB, Jung YS, Kim YH, Park DH, Lee SS, Seo DW, Lee SK, Kim MH, Kwang MP, Lee YJ. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: Improvement with surgical experience. Surg Endosc 2013;27:95-103.

    Article  PubMed  Google Scholar 

  11. Gumbs AA, Croner R, Rodriguez A, Zuker N, Perrakis A, Gayet B. 200 consecutive laparoscopic pancreatic resections performed with a robotically controlled laparoscope holder. Surg Endosc 2013;27:3781-3791.

    Article  PubMed  Google Scholar 

  12. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Total laparoscopic pancreaticoduodenectmoy for pancreatic ductal adenocarcinoma: Oncologic advantages over open approaches? Ann Surg 2014;260:633-640.

    Article  PubMed  Google Scholar 

  13. Senthilnathan P, Gurumurthy SS, Gul SI, Sabnis S, Ntesan AV, Palanisamy NV, Raj PP, Subbiah R, Ramakrishnan P, Palanivelu C. Long-term results of laparoscopic pancreaticoduodenectomy for pancreatic and periampullary cancer – Experience of 130 cases from a tertiary-care center in South India. J Laparoendosc Adv Surg Tech A 2015;25:295-300.

    Article  PubMed  Google Scholar 

  14. Sharpe SM, Talamonti MS, Wang CE, Prinz RA, Roggin KK, Bentrem DJ, Winchester DJ, Marsh RDW, Stocker SJ, Baker MS. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: A comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg 2015;221:175-184.

    Article  PubMed  Google Scholar 

  15. Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A. Robot-assisted laparoscopic pancreatic surgery: Single-surgeon experience. Surg Endosc. 2010;24:1646-1657.

    Article  PubMed  Google Scholar 

  16. Boone BA, Zenati M, Hogg ME, Steve J, Moser AJ, Bartlett DL, Zeh HJ, Zureikat AH. Assessment of quality outcomes for robotic pancreaticoduodenectomy: Identification of the learning curve. JAMA Surg 2015;150:416-422.

    Article  PubMed  Google Scholar 

  17. Boggi U, Amorese G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Mosca F. Laparoscopic pancreaticoduodenectomy: A systematic literature review. Surg Endosc 2015;29:9-23.

    Article  PubMed  Google Scholar 

  18. Correa-Gallego C, Dinkelspiel HE, Sulimanoff I, Fisher S, Vineula EF, Kingham TP, Fong Y, DeMatteo RP, D’Angelica MI, Jarnagin WR, Allen PJ. Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 2014;218:129-139.

    Article  PubMed  Google Scholar 

  19. Nigri G, Petrucciani N, La Torre M, Magistri P, Valabrega S, Aurello P, Ramacciato G. Duodenopancreatectomy: Open or minimally invasive approach? Surgeon 2014;12:227-234.

    Article  PubMed  Google Scholar 

  20. Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer III DG, Roman SA, Sosa JA. Minimally invasive versus open pancreaticoduodenectomy for cancer: Practice patterns and short-term outcomes among 7061 patients. Ann Surg 2015;262:372-377.

    Article  PubMed  Google Scholar 

  21. Nussbaum DP, Adam MA, Youngwirth LM, Ganapathi AM, Roman SA, Tyler DS, Sosa JA, Blazer III DG. Minimally invasive pancreaticoduodenectomy does not improve use or time to initiation of adjuvant chemotherapy for patients with pancreatic adenocarcinoma. 2015 Nov 5;Epub ahead of print.

  22. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 2005;137:597-605.

    Article  PubMed  Google Scholar 

  23. Fernandez-Cruz L, Cosa R, Blanco L, Levi S, Lopez-Boado MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: A critical analysis from a single institution. J Gastrointest Surg 2007;11:1607-1622.

    Article  PubMed  Google Scholar 

  24. Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin II RCG, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnson 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. Left-sided pancreatectomy: Multicenter comparison of laparoscopic and open approaches. Ann Surg 2008;248:438-446.

    PubMed  Google Scholar 

  25. Røsok BI, Marangos IP, Kazaryan AM, Rosseland AR, Buanes T, Mathisen Ø, Edwin B. Single-centre experience of laparoscopic pancreatic surgery. Br J Surg 2010;97:902-909.

    Article  PubMed  Google Scholar 

  26. Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, Donohue JH, Farnell MB, Kendrick ML. Laparoscopic vs open distal pancreatectomy: A single-institution comparative study. Arch Surg 2010;145:616-621.

    Article  PubMed  Google Scholar 

  27. DiNorcia J, Schrope BA, Lee MK, Reavey PL, Rosen SJ, Lee JA, Chabot JA, Allendorf JD. Laparoscopic distal pancreatectomy offers shorter hospital stays with fewer complications. J Gastrointest Surg 2010;14:1804-1812.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park DH, Han DJ. Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: Changing the surgical paradigm of left pancreatic resection. Surg Endosc 2011;25:3364-3372.

    Article  PubMed  Google Scholar 

  29. Kneuertz PJ, Patel SH, Chu CK, Fisher SB, Maithel SK, Sarmiento JM, Weber SM, Staley CA, Kooby DA. Laparoscopic distal pacnreatectomy: Trends and lessons learned through an 11-year experience. J Am Coll Surg 2012;215:167-176.

    Article  PubMed  Google Scholar 

  30. Stauffer JA, Rosales-Velderrain A, Goldberg RF, Bowers SP, Asbun HJ. Comparison of open with laparoscopic distal pancreatectomy: A single institution’s transition over a 7-year period. HPB 2013;15:149-155.

    Article  PubMed  Google Scholar 

  31. Adam JP, Jacquin A, Laurent C, Collet D, Masson B, Fernandez-Cruz L, Sa-Cunha A. Laparoscopic spleen-preserving distal pancreatectomy: Splenic vessel preservation compared with the Warshaw technique. JAMA Surg 2013;148:246-252.

    Article  Google Scholar 

  32. Braga M, Pecorelli N, Ferrari D, Balzano G, Zuliani W, Castoldi R. Results of 100 conseutive laparoscopic distal pancreatectomies: Postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc 2015;29:1871-1878.

    Article  PubMed  Google Scholar 

  33. de Rooij T, Jilesen AP, Boerma D, Bonsing BA, Bosscha K, van Dam RM, van Dieren S, Dijkgraaf MG, van Eijck CH, Gerhards MF, van Goor H, van der Harst E, de Hingh IH, Kazemier G, Klaase JM, Molenaar IQ, van Dijkum EJN, Patijn GA, van Santvoort HC, Scheepers JJ, van der Schelling GP, Sieders E, Vogel JA, Busch OR, Besselink MG, for the Dutch Pancreatic Cancer Group. A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease. J Am Coll Surg 2015;220:263-270.

    Article  PubMed  Google Scholar 

  34. Sharpe SM, Talamonti MS, Wang E, Bentrem DJ, Roggin KK, Prinz RA, Marsh RDW, Stocker SJ, Winchester DJ, Baker MS. The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg 2015;209:557-563.

    Article  PubMed  Google Scholar 

  35. Sahakyan MA, Kazaryan AM, Rawashdeh M, Fuks D, Shmavonyan M, Haugvik SP, Labori KJ, Buanes T, Røsok BI, Ignjatovic D, Hilal MA, Gayet B, Kim SC, Edwin B. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: Results of a multicenter cohort study on 196 patients. Surg Endosc 2015 Oct 30;Epub ahead of print.

  36. Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A, Delpero JR, on behalf of the ACHBT French Pancreatectomy Study Group. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: Time for a randomized controlled trial? Results of an all-inclusive national observational study. Ann Surg 2015;262:868-874.

    Article  PubMed  Google Scholar 

  37. Napoli N, Kauffmann EF, Perrone VG, Miccoli M, Brozzetti S, Boggi U. The learning curve in robotic distal pancreatectomy. Updates Surg 2015;67:257-264.

    Article  PubMed  Google Scholar 

  38. Shakir M, Boone BA, Polanco PM, Zenati MS, Hogg ME, Tsung A, Choudry HA, Moser AJ, Bartlett DL, Zeh HJ, Zureikat AH. The learning curve for robotic distal pancreatectomy: An analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB 2015;17:580-586.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM. Robotic distal pancreatectomy: Cost effective? Surgery 2010;148:814-823.

    Article  PubMed  Google Scholar 

  40. Kang CM, Kim DH, Lee WJ, Chi HS. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 2011;25:2004-2009.

    Article  PubMed  Google Scholar 

  41. Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 2013;257:128-132.

    Article  PubMed  Google Scholar 

  42. Butturini G, Damoli I, Crepax L, Malleo G, Marchegiani G, Daskalaki D, Esposito A, Cingarlini S, Salvia R, Bassi C. A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc 2015;29:3163-3170.

    Article  PubMed  Google Scholar 

  43. Chen S, Zhan Q, Chen JZ, Jin JB, Deng XX, Chen H, Shen BY, Peng CH, Li HW. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: A matched cohort study. Surg Endosc 2015;29:3507-3518.

    Article  PubMed  Google Scholar 

  44. Lee SY, Allen PJ, Sadot E, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Kingham TP. Distal pancreatectomy: A single institution’s experience in open, laparoscopic, and robotic approaches. 2015;220:18-27.

  45. Adam MA, Choudhury K, Goffredo P, Reed SD, Blazer III D, Roman SA, Sosa JA. Minimally invasive distal pancreatectomy for cancer: Short-term oncologic outcomes in 1733 patients. World J Surg 2015;39:2564-2572.

    Article  PubMed  Google Scholar 

  46. Song KB, Kim SC, Hwang DW, Lee JH, Lee DJ, Lee JW, Jun ES, Sin SH, Kim HE, Park KM, Lee YJ. Enucleation for benign or low-grade malignant lesions of the pancreas: Single-center experience with 65 consecutive patients. Surgery 2015;158:1203-1210.

    Article  PubMed  Google Scholar 

  47. Sa Cunha A, Rault A, Beau C, Collet D, Masson B. Laparoscopic central pancreatectomy: Single institution experience of 6 patients. Surgery 2007;142:405-409.

    Article  PubMed  Google Scholar 

  48. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh III HJ. 250 Robotic pancreatic resections: Safety and feasibility. Ann Surg 2013;258:554-562.

    PubMed  PubMed Central  Google Scholar 

  49. Khaled YS, Malde DJ, Packer J, Fox T, Laftsidis P, Ajala-Agbo T, De Ligurori Carino N, Deshpande R, O’Reilly DA, Sherlock DJ, Ammori BJ. Laparoscopic versus open cystgastrostomy for pancreatic pseudocyst: a case-matched comparative study. J Hepatobiliary Pancreat Sci 2014;21:818-823.

    Article  PubMed  Google Scholar 

  50. Wright JD, Ananth CV, Tergas AI, Herzog TJ, Burke WM, Lewin SN, Lu YS, Neugut AI, Hershman DL. An economic analysis of robotically assisted hysterectomy. Obstet Gynecol 2014;123:1038-1048.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Geller EJ, Matthews CA. Impact of robotic operative efficiency on profitability. Am J Obstet Gynecol 2013;209:20.e1-5.

    Article  Google Scholar 

  52. Tran TB, Dua MM, Worhunsky DJ, Poultsides GA, Norton JA, Visser BC. The first decade of laparoscopic pancreaticoduodenectomy in the United States: Costs and outcomes using the Nationwide Inpatient Sample. Surg Endosc 2015 Aug 15;Epub ahead of print.

Download references

Author information

Authors and Affiliations

  1. Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Center Ave, Suite 421, Pittsburgh, PA, 15232, USA

    G. Paul Wright & Amer H. Zureikat

Authors
  1. G. Paul Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amer H. Zureikat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amer H. Zureikat.

Additional information

Questions & Answers

1)When performed at high volume centers, by experienced high volume pancreatic surgeons on select case, minimally invasive pancreaticoduodenectomy is associated with similar morbidity compared to the open approach

a.True

b.False

2)An advantage of minimally invasive pancreaticoduodenectomy over the open approach is:

a.Lower mortality rate

b.Shorter operative time

c.Lower operative blood loss

d.Lower morbidity rate

3)A potential advantage of robotic distal pancreatectomy over the laparoscopic approach includes:

a.Reduced operative time

b.Reduced length of stay

c.Lower morbidity rate

d.Higher splenic preservation and lower conversion rate

4)The learning curve for robotic distal pancreatectomy is reported to be around:

a.10 cases

b.20 cases

c.40 cases

d.60 cases

5)If performed by experienced high volume pancreatic surgeons, the oncologic efficacy of minimally invasive pancreatectomy is inferior to the open approach:

a.True

b.False

6)Mortality rate is higher for robotic distal pancreatectomy when compared with laparoscopic distal pancreatectomy:

a.True

b.False

7)Future comparative effectiveness studies of minimally invasive versus open pancreatectomy should take into consideration the following factors:

a.Surgeon experience

b.Surgeon volume

c.The effect of the learning curve on outcomes

d.Case selection

e.All of the above

Disclosure Information: Authors: Amer H. Zureikat, M.D. has nothing to disclose; G. Paul Wright, M.D. has nothing to disclose. Editors-in-Chief: Jeffrey B. Matthews, M.D., has nothing to disclose; Charles Yeo, M.D., has nothing to disclose. CME Overseers: Arbiter: Jeffrey B. Matthews, M.D., has nothing to disclose; Vice-Arbiter: Ranjan Sudan, M.D., has nothing to disclose; Question Reviewers: I. Michael Leitman, M.D. has nothing to disclose; Peter Lopez, M.D., has nothing to disclose.

CME questions for this article available to SSAT members at http://ssat.com/jogscme/

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wright, G.P., Zureikat, A.H. Development of Minimally Invasive Pancreatic Surgery: an Evidence-Based Systematic Review of Laparoscopic Versus Robotic Approaches. J Gastrointest Surg 20, 1658–1665 (2016). https://doi.org/10.1007/s11605-016-3204-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3204-1

Keywords

Search

Navigation