A single institution experience with robotic and laparoscopic distal pancreatectomies

Abstract

Backgrounds/Aims: This study aims to describe our experience with minimally-invasive distal pancreatectomies, with emphasis on the comparison between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). Methods: Retrospective review of 102 consecutive RDP and LDP from 2006 to 2019 was performed. Results: There were 27 and 75 patients who underwent RDP and LDP, respectively. There were 12 (11.8%) open conversions and 16 (15.7%) patients had major (＞grade 2) morbidities. Patients who underwent RDP had significantly higher rates of splenic preservation (44.4% vs. 13.3%, p=0.002), higher rates of splenic-vessel preservation (40.7% vs. 9.3%, p=0.001), higher median difficulty score (5 vs. 3, p=0.002) but longer operation time (385 vs. 245 minutes, p＜0.001). The rate of open conversion tended to be lower with RDP (3.7% vs. 14.7%, p=0.175). Conclusions: In our institution practice, both RDP and LDP were safe and effective. The use of RDP appeared to be complementary to LDP, allowing us to perform more difficult procedures with comparable postoperative outcomes.

Minimally invasive distal pancreatectomy: Laparoscopic versus robotic approach—A cohort study

“…There is no surgical mortality in both RDP and LDP groups in our series. Many authors also reported similar findings like ours 3,12,14,16,27,28 . Technically, RDP and LDP are comparable in terms of feasibility and safety.…”

“…Thus, when choosing the type of MIS adopted, the cost would be a major factor to consider if patients had to pay an additional amount for robotic surgery. Although the cost of robotic surgery could vary between institutions and countries, nevertheless, it is uniformly higher than conventional laparoscopic surgery 27 …”

“…Although the cost of robotic surgery could vary between institutions and countries, nevertheless, it is uniformly higher than conventional laparoscopic surgery. 27 The limitation of this study is that this study is a retrospective and unmatched comparison between two techniques done by the same surgical team in two different time periods. Thus, the biases related to surgical skill and experience in different time periods would be inevitable, although propensity matching analysis has been claimed to minimize the selection bias that occurred in this retrospective study.…”

“…Robotic surgery has been blamed for its longer operation time in many surgical fields including RDP, 1,16,25,27,29 because of additional time for docking the robotic machine and changing robotic working instruments. However, this concern did not occur in our study, and a shorter operation time of RDP was observed (a median of 162 vs. 210 min, p = 0.005).…”

“…Therefore, robotic systems with these advantages would be expected to allow fine and precise dissection and, moreover, facilitate hemostasis and suturing in complex pancreatic surgery. Some authors claimed that RDP could be associated with a lower open conversion rate, less blood loss, higher spleen preservation rate, and more harvested lymph nodes, 1,16,27 but not all of these advantages of RDP were uniformly confirmed. Our study showed that although there was a tendency toward lower conversion rate, higher spleenpreservation rate, shorter operation time, and less blood loss in the RDP group, all of them were not statistically significant, as compared with LDP.…”