Comparison of surgical outcomes among open, laparoscopic, and robotic pancreatoduodenectomy: a single-center retrospective study

Abstract

Background There is no general consensus on the feasibility and safety of robotic pancreatoduodenectomy (RPD) and whether it increases surgical risks. The purpose of this study was to assess the safety, feasibility, and rationality of RPD by comparing perioperative data among open pancreatoduodenectomy (OPD), laparoscopic pancreatoduodenectomy (LPD), and RPD performed in our center in recent years. Methods Clinical data of patients had undergone RPD (n = 32), LPD (n = 21), and OPD (n = 86) in The First Affiliated Hospital of Guangxi Medical University between January 2016 and June 2020 were retrospectively collected and analyzed. Results RPD required more time for operation (537.2 min vs. 441.5 min, p < 0.001) than OPD did, but less time to remove abdominal drainage tube (12.5 d vs. 17.3 d, p = 0.001). The differences between the RPD group and LPD group were interesting, as the two groups had similar operation time (537.2 min vs. 592.9 min, p = 1.000) and blood loss (482.8 ml vs. 559.5 ml, p > 0.05), but the RPD group had a higher activity of daily living score on postoperative day 3 (35.8 vs. 25.7, p = 0.0017) and a lower rate of conversion to OPD (6.5% vs. 38.1%, p = 0.011). Regarding complications, such as the postoperative pancreatic fistula, abdominal hemorrhage, intra-abdominal infection, bile leakage, reoperation, and perioperative mortality, there were no significant differences among the three groups. Conclusions Not only is RPD feasible and reliable, it also offers significant advantages in that it improves postoperative recovery of skills needed for everyday life, has a low conversion rate to open surgery, and does not increase surgical risks.

An assessment of perioperative outcomes for open, laparoscopic, and robot‐assisted pancreaticoduodenectomy

“…Some studies have shown that prolonging the operation time will increase the perioperative complications and mortality of PD. 8 Prolonged operation time often means increased possibility of intraoperative bleeding and blood transfusion.…”

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

“…6,7 Compared with open pancreaticoduodenectomy (OPD), RPD is more feasible to perform complex surgery with the advantage of three-dimensional binocular vision and high degrees of freedom. [8][9][10] And with modified ergonomics and elevated dexterity, RPD reduces surgeon fatigue and allows for greater performance of the surgeon's skills. 11,12 RPD is considered to have many advantages over OPD, such as lower blood loss, reduced perioperative complications, faster postoperative recovery, and comparable oncology outcomes.…”

“…[13][14][15][16] RPD is rapidly developing in China, although it has not yet been commonly adopted due to the high cost of instruments and the inexperience of the surgeon. 9,13 The postoperative healthcare-associated infections (HAIs), as one of the common postoperative complications of PD, have a profound impact on the prognosis of patients and the cost of medical care and increase the risk of mortality. [17][18][19] Owing to the presence of a learning curve and the complexity of the surgery, 16,20 RPD is no exception to the risk of postoperative HAIs.…”

“…Since RPD was presented in 2003, 5 with the improvement of surgical instruments and equipment, and the accumulation of surgical experience of surgeons, more patients have started to undergo RPD and achieved favorable outcomes 6,7 . Compared with open pancreaticoduodenectomy (OPD), RPD is more feasible to perform complex surgery with the advantage of three‐dimensional binocular vision and high degrees of freedom 8–10 . And with modified ergonomics and elevated dexterity, RPD reduces surgeon fatigue and allows for greater performance of the surgeon's skills 11,12 .…”

“…RPD is considered to have many advantages over OPD, such as lower blood loss, reduced perioperative complications, faster postoperative recovery, and comparable oncology outcomes 13–16 . RPD is rapidly developing in China, although it has not yet been commonly adopted due to the high cost of instruments and the inexperience of the surgeon 9,13 …”