Distal Pancreatectomy and Splenectomy: A Robotic or LESS Approach

Abstract

Introduction:The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy.Methods:With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD.Results:Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery.Conclusions:Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.

Minimally Invasive Distal Pancreatectomy: Review of the English Literature

“…[50][51][52] However, there was no significant difference in intraoperative blood loss, conversion to open surgery, spleen preserving, postoperative complications, and length of postoperative hospital stay between the two groups. [50][51][52][53][54][55] For malignant tumors, the rates of negative surgical margins and the number of lymph nodes harvested were higher in R-LDP. 54 However, some other studies reported that there were no significant differences between the two groups.…”

The Role of the Single Incision Laparoscopic Approach in Liver and Pancreatic Resectional Surgery

“…Supine [2, 32, 34, 36, 38, 39], right lateral [35], and semilateral [33, 37] positions with [2, 32, 34, 38, 39] or without legs apart have been described, while reverse Trendelenburg after establishing the pneumoperitoneum was used by all groups. The surgical technique described is similar among the reports with minor modifications.…”

Robot-assisted distal pancreatectomy: Technical aspects and results

“…К концу 2015 г. в мировой литературе было опубликовано 426 слу-чаев выполнения этой операции [13][14][15][16][17][18]. Показаниями к операции послужили нейроэндокринная опухоль (29%), протоковая аденокарцинома (23,9%), серозная или муци-нозная цистаденома (22,6%), внутрипротоковая папилляр-но-муцинозная опухоль (20%), другие заболевания (4,5%) [19][20][21][22].…”