Outcome of robot-assisted pancreaticoduodenectomy during initial learning curve versus laparotomy

Abstract

to analyze the initial learning curve (Lc) for robot-assisted pancreaticoduodenectomy (RApD) and compare RApD during the initial Lc with open pancreaticoduodenectomy (opD) in terms of outcome. this study is a retrospective review of patients who consecutively underwent RApD and opD between October 2015 and January 2020 in our hospital. 41 consecutive RAPD cases and 53 consecutive open cases were enrolled for review. Compared with OPD, RAPD required a significantly longer operative time (401.1 ± 127.5 vs. 230.8 ± 44.5 min, P < 0.001) and higher cost (194621 ± 78342 vs. 121874 ± 39973 CNY, P < 0.001). Moreover, compared with the OPD group, the RAPD group revealed a significantly smaller mean number of lymph nodes harvested in malignant cases (15.6 ± 5.9 vs 18.9 ± 7.3, P = 0.025). No statistically significant differences were observed between the two groups in terms of incidence of Clavien-Dindo grade III-V morbidities and 90-day mortality and readmission (p>0.05). In the CUSUM graph, one peak point was observed at the 8th case, after which the operation time began to decrease. LC for RAPD may be less than 30 cases, and RAPD is safe and feasible during the initial Lc. Although pancreatectomy was first performed 80 years ago, it remains a challenging abdominal surgery with relatively high morbidity and mortality 1. Laparoscopic pancreaticoduodenectomy (LPD) was first reported in 1994 by Gagner 2 ; today, this procedure could be performed as safely as open pancreaticoduodenectomy (OPD) by skilled surgeons 3,4. However, the long learning curve (LC) for LPD continues to challenge many surgeons. In general, LPD presents intrinsic disadvantages compared with conventional laparotomy, including instrument motion, two-dimensional imaging, poor surgeon ergonomics, and a long LC. In 2000, the Da Vinci system was approved by the Food and Drug Administration. In 2003, Giulianotti et al. published a case series verifying the feasibility of robotic pancreatectomy; the series included eight robot-assisted pancreaticoduodenectomy (RAPD) and five robot-assisted distal pancreatectomy (RADP) cases 5. Robotic surgery is an advanced minimally invasive surgical technique that has several benefits in pancreaticoduodenectomy, such as enhanced three-dimensional vision, application of EndoWrist instruments (which have a great range of motion), and a short LC. However, the safety of RAPD during the initial LC and the possible shortening of the LC remain unclear. Therefore, this article addresses the LC of a single surgical team in our hospital. Methods patient Selection. This study is a retrospective research on pancreaticoduodenectomy conducted by a single surgical team. Our team had performed over 200 OPD before

Establishment and Application of a Novel Difficulty Scoring System for da Vinci Robotic Pancreatoduodenectomy

“…No one else has done similar research in RPD before. The operation time, intraoperative blood loss, conversion to laparotomy rate, and complications (Clavien–Dindo grade ≥ 3) in this study are similar to those reported in other single-center or multicenter reports ( 32 , 42 , 43 ), so our DSS-Han for the RPD system may also be comparable in other institutions. We first discover and propose the concept of mesenteric tissue thickness (P1) in clinical practice.…”

Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms

“…Either laparoscopic or robotic NOSES could be performed in our department 24 , 25 . As per our experience, especially in ultra-low rectal cancer, robotic NOSES has advantage compared with laparoscopic NOSES.…”

Surgical training model and safe implementation of robotic pancreatoduodenectomy in Japan: a technical note

“…However, providing a specific number of procedures to be an independent assistant and operator would be cumbersome because the learning curve may be affected by several factors, including previous experiences in pancreatic surgery and minimally invasive surgery. The learning curve for RPD has been reported to be different from approximately 30 to 80 cases [ 13 – 16 ]. Therefore, at least 30 cases may be required to become an independent assistant or operator.…”