Figures do matter: A literature review of 4587 robotic pancreatic resections and their implications on training

Sandri, Giovanni Battista Levi; Hilal, Mohammed Abu; Dokmak, Safi; Edwin, Bjørn; Hackert, Thilo; Keck, Tobias; Khatkov, Igor; Besselink, Marc G.; Boggi, Ugo

doi:10.1002/jhbp.1209

Cited by 7 publications

(5 citation statements)

References 99 publications

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“…Pneumoperitoneum intolerance was observed in 2 of 10 patients which resulted in conversion to a mini-laparotomy for PJ and HJ reconstruction. A recent review of 4587 RPD cases demonstrated that the conversion rate due to pneumoperitoneum intolerance was 8.3% [ 19 ]. The higher incidence in our series might have been attributable to the prolonged median operation time of 634 min.…”

Section: Discussionmentioning

confidence: 99%

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Introduction of robotic pancreatoduodenectomy following phase 2a IDEAL guidelines

Mise,

Miyashita,

Yoshioka

et al. 2024

PLoS ONE

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Background Robotic pancreatoduodenectomy (RPD) is a newly introduced procedure, which is still evolving and lacks standardization. An objective assessment is essential to investigate the feasibility of RPD. The current study aimed to assess our initial ten cases of RPD based on IDEAL (Idea, Development, Exploration, Assessment, and Long-term study) guidelines. Methods This was a prospective phase 2a study following the IDEAL framework. Ten consecutive cases of RPD performed by two surgeons with expertise in open procedures at a single center were assigned to the study. With objective evaluation, each case was classified into four grades according to the achievements of the procedures. Errors observed in the previous case were used to inform the procedure in the next case. The surgical outcomes of the ten cases were reviewed. Results The median total operation time was 634 min (interquartile range [IQR], 594–668) with a median resection time of 363 min (IQR, 323–428) and reconstruction time of 123 min (IQR, 107–131). The achievement of the whole procedure was graded as A, “successful”, in two patients. In two patients, reconstruction was performed with a mini-laparotomy due to extensive pneumoperitoneum, probably caused by insertion of a liver retractor from the xyphoid. Major postoperative complications occurred in two patients. One patient, in whom the jejunal limb was elevated through the Treitz ligament, had a bowel obstruction and needed to undergo re-laparotomy. Conclusions RPD is feasible when performed by surgeons experienced in open procedures. Specific considerations are needed to safely introduce RPD.

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Section: Discussionmentioning

confidence: 99%

“…Although the evaluators judged resection would be safely completed 240 min after the resection began, the median resection time was 363 min, and 5 cases exceeded this criterion. Considering that the reported operation time of RPD ranges widely, from 188 to 718 min [ 19 ], the criterion of operation time should not have been set so rigidly.…”

Section: Discussionmentioning

confidence: 99%

Introduction of robotic pancreatoduodenectomy following phase 2a IDEAL guidelines

Mise,

Miyashita,

Yoshioka

et al. 2024

PLoS ONE

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“…The need for prudent implementation of RPD-VR is further reinforced by the lack of comparative studies with the open procedure, and by the fact that only few centers have performed a good number of RPDs. A recent review demonstrated that up to march 2021 only 28 centers had reported on RPD [ 49 ]. Number of PDs per center ranged from 6 to 500.…”

Section: Discussionmentioning

confidence: 99%

Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction

et al. 2023

Self Cite

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Background Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study provided a detailed description of the technical challenges associated with this formidable operation. Herein, we describe the trips and tricks for technically successful RPD-VR. Methods The vascular techniques used in RPD-VR were borrowed from OPD-VR, as well as from our experience with robotic transplantation of both kidney and pancreas. Vein resection was classified into 4 types according to the international study group of pancreatic surgery. Each type of vein resection was described in detail and shown in a video. Results Between October 2008 and November 2021, a total of 783 pancreatoduodenectomies were performed, including 233 OPDs-VR (29.7%). RPD was performed in 256 patients (32.6%), and RPDs-VR in 36 patients (4.5% of all pancreatoduodenectomies; 15.4% of all pancreatoduodenectomies with vein resection; 14.0% of all RPDs). In RPD-VR vein resections were: 4 type 1 (11.1%), 10 type 2 (27.8%), 12 type 3 (33.3%) and 10 type 4 (27.8%). Vascular patches used in type 2 resections were made of peritoneum (n = 8), greater saphenous vein (n = 1), and deceased donor aorta (n = 1). Interposition grafts used in type 4 resections were internal left jugular vein (n = 8), venous graft from deceased donor (n = 1) and spiral saphenous vein graft (n = 1). There was one conversion to open surgery (2.8%). Ninety-day mortality was 8.3%. There was one (2.8%) partial vein thrombosis, treated with heparin infusion. Conclusions We have reported 36 technically successful RPDs-VR. We hope that the tips and tricks provided herein can contribute to safer implementation of RPD-VR. Based on our experience, and according to data from the literature, we strongly advise that RPD-VR is performed by expert surgeons at high volume centers. Graphical abstract

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“…Although robotic distal pancreatectomy has spread rapidly over the last two decades [ 7 ], the procedures have been performed using the da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) [ 8 ]. Recently, companies worldwide have developed new robotic surgical systems characterized by unique technical refinements, because of the death of some patents related to the da Vinci ® system [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Robotic spleen-preserving distal pancreatectomy using the first domestic surgical robot platform (the hinotori™ Surgical Robot System): a case report

Tomihara,

Ide,

Ito

et al. 2024

surg case rep

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Background Robotic pancreatectomy has been performed worldwide mainly using the da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Recently, because of the death of some patents related to the da Vinci® system, new surgical robot systems have been introduced that are characterized by unique technical refinements. In Japan, the hinotori™ Surgical Robot System (Medicaroid Corporation, Kobe, Japan) was approved for use in gastroenterological surgery in October 2022. Since then, we have attempted complicated procedures using this robot. In this report, we report our first experience performing spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein using this first Japanese domestic surgical robot. Case presentation The patient was a 58-year-old woman with a mass in the pancreatic tail identified during medical screening. Further examinations resulted in a diagnosis of a pancreatic neuroendocrine tumor. The patient consented to surgical resection, and we planned robotic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein, using the hinotori™. Five trocars, including one port for the assistant surgeon, were placed in the upper abdomen. The operating unit was rolled in from the patient’s right side. The pivot position was set for each robotic arm, and this setting was specific to the hinotori™. The cockpit surgeon performed all surgical procedures, excluding port placement and pancreatic transection. There were no unrecoverable device errors during the operation. The operation time was 531 min, and blood loss was 192 ml. The postoperative course was uneventful. We were able to safely perform this highly complicated surgery for a pancreatic tumor using the first Japanese domestic surgical robot platform. Conclusions The first Japanese domestic surgical robot platform, hinotori™, has different features from those of the da Vinci® and performed sufficiently as a surgical robot system in highly advanced pancreatic surgery.

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Figures do matter: A literature review of 4587 robotic pancreatic resections and their implications on training

Cited by 7 publications

References 99 publications

Introduction of robotic pancreatoduodenectomy following phase 2a IDEAL guidelines

Introduction of robotic pancreatoduodenectomy following phase 2a IDEAL guidelines

Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction

Robotic spleen-preserving distal pancreatectomy using the first domestic surgical robot platform (the hinotori™ Surgical Robot System): a case report

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