Objective. To assess the role of minimally invasive surgery for periampullary cancer.Material and methods. A systematic literature review of original articles devoted to comparison of open, laparoscopic and robot-assisted pancreatoduodenectomy was performed. Also, our own experience of minimally invasive pancreatoduodenectomy is shown.Results. Articles included in the analysis showed comparable results of minimally invasive and open pancreatoduodenectomy regarding morbidity, mortality and oncological outcomes. Laparoscopic and robot-assisted pancreatoduodenectomy are associated with significantly less intraoperative blood loss and length of postoperative hospital-stay. However, these procedures require more time.Conclusion. Minimally invasive surgery does not worsen perioperative outcomes and may be considered as an alternative to open procedures in selective patients. Minimally invasive techniques should be implemented in highvolume pancreatic centers only with specialists experienced in minimally invasive surgery.
Background. Minimally invasive radical surgery for perihilar cholangiocarcinoma is in its early stages. Aim. A comparative analysis of the initial experience of robot-assisted and open resections for perihilar cholangiocarcinoma. Material and methods. The single-center experience, accumulated over the period from 2014 to 2018, is analyzed. Robot-assisted procedures included major liver resection and caudate lobectomy with extrahepatic bile duct resection and lymphadenectomy. The need for vascular reconstruction was considered a contraindication to surgery. Results. Thirteen robot-assisted resections were performed. The perihilar cholangiocarcinoma was confirmed by pathologic examination in 10 patients. The immediate outcomes were compared with that in 88 open procedures. There were no significant differences in blood loss, the rate of severe morbidity, mortality, and hospital stay. The duration of the robot-assisted surgical resections was significantly longer. Conclusion. Analysis of initial experience justifies the robotic approach for radical resection in highly selected patients.
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