Perioperative Outcomes of Robotic Pancreaticoduodenectomy: a Propensity-Matched Analysis to Open and Laparoscopic Pancreaticoduodenectomy

Oosten, A. Floortje van; Ding, Ding; Irfan, Ahmer; Schmocker, Ryan K.; Sereni, Elisabetta; Kinny‐Köster, Benedict; Wright, Michael J.; Groot, Vincent P.; Molenaar, I. Quintus; Cameron, John L.; Makary, Martin A.; Burkhart, Richard A.; Burns, William R.; Wolfgang, Christopher L.; He, Jin

doi:10.1007/s11605-020-04869-z

Cited by 51 publications

(39 citation statements)

References 36 publications

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“…Hence, in accordance with other data already reported in literature, the most relevant consequence of the better post-operative course after RPD positively impacting on costs was the significantly shorter LoS [4,26,27,33,34]. Indeed, despite the minimal differences in clinical outcomes between the two groups, the stay of the open group was meaningful 6 days longer, likewise or even better to data reported by some authors in series showing no differences in term of overall post-operative complications between OPD and RPD [35,36].…”

Section: Discussionsupporting

confidence: 92%

“…Another key point of our analysis is the reported OT. Indeed, while robotic procedures have been traditionally associated to longer OT respect to open ones, also for PD [4,33,34], in our series no differences were reported in terms of OT between RPD and OPD, therefore overcoming also this second criticism of RAS. Many factors could explain this data.…”

Section: Discussionmentioning

confidence: 44%

“…Robotic assisted surgery (RAS) emerged as a potential alternative to laparoscopy, overcoming some of its intrinsic limitations. Since Giulianotti et al [3] reported the first case of robot-assisted PD in 2003, several studies have compared robotic and open pancreatoduodenectomy (OPD), showing that robotic pancreatoduodenectomy (RPD) is a feasible and safe procedure for both benign and malignant pathologies [4]. Some studies have demonstrated that RPD reduces estimated blood loss and length of post-operative stay in comparison to OPD [5][6][7] and that RPD is associated with better oncological outcomes respect to OPD, showing superiority in terms of disease-free survival, time to starting adjuvant chemotherapy, and rate of negative margins [8].…”

mentioning

confidence: 99%

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Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach

et al. 2021

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Background Robot-assisted pancreatoduodenectomy (RPD) has shown some advantages over open pancreatoduodenectomy (OPD) but few studies have reported a cost analysis between the two techniques. We conducted a structured cost-analysis comparing pancreatoduodenectomy performed with the use of the da Vinci Xi, and the traditional open approach, and considering healthcare direct costs associated with the intervention and the short-term post-operative course. Twenty RPD and 194 OPD performed between January 2011 and December 2020 by the same operator at our high-volume multidisciplinary center for robot-assisted surgery and for pancreatic surgery, were retrospectively analyzed. Two comparable groups of 20 patients (Xi-RPD-group) and 40 patients (OPD-group) were obtained matching 1:2 the RPD-group with the OPD-group. Perioperative data and overall costs, including overall variable costs (OVCs) and fixed costs, were compared. Materials and methods ResultsNo difference was reported in mean operative time: 428 min for Xi-RPD-group versus 404 min for OPD, p = 0.212. The median overall length of hospital stay was significantly lower in the Xi-RPD-group: 10 days versus 16 days, p = 0.001. In the Xi-RPD-group, consumable costs were significantly higher (€6149.2 versus €1267.4, p < 0.001), while hospital stay costs were significantly lower: €5231.6 versus €8180 (p = 0.001). No significant differences were found in terms of OVCs: €13,483.4 in Xi-RPD-group versus €11,879.8 in OPD-group (p = 0.076). Conclusions Robot-assisted surgery is more expensive because of higher acquisition and maintenance costs. However, although RPD is associated to higher material costs, the advantages of the robotic system associated to lower hospital stay costs and the absence of difference in terms of personnel costs thanks to the similar operative time with respect to OPD, make the OVCs of the two techniques no longer different. Hence, the higher costs of advanced technology can be partially compensated by clinical advantages, particularly within a high-volume multidisciplinary center for both robot-assisted and pancreatic surgery. These preliminary data need confirmation by further studies.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 44%

mentioning

confidence: 99%

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Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach

et al. 2021

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“…Finally, a total of 523 relevant English and Chinese publications from various electronic databases were yielded. Finally, according to the inclusion criteria, 9 retrospective studies (12)(13)(14)(15)(16)(17)(18)(19)(20) comparing RPD and LPD in a total of 3,732 patients (1,149 and 2,583 patients underwent RPD and LPD, respectively) were included for further analysis. A flow diagram of our analysis protocol is shown in Figure 1.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

et al. 2022

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BackgroundAlthough minimally invasive pancreaticoduodenectomy has gained worldwide interest, there are limited comparative studies between two minimally invasive pancreaticoduodenectomy techniques. This meta-analysis aimed to compare the safety and efficacy of robotic and laparoscopic pancreaticoduodenectomy (LPD), especially the difference in the perioperative and short-term oncological outcomes.MethodsPubMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before July 2021. Data on operative times, blood loss, overall morbidity, major complications, vascular resection, blood transfusion, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), conversion rate, reoperation, length of hospital stay (LOS), and lymph node dissection were subjected to meta-analysis.ResultsOverall, the final analysis included 9 retrospective studies comprising 3,732 patients; 1,149 (30.79%) underwent robotic pancreaticoduodenectomy (RPD), and 2,583 (69.21%) underwent LPD. The present meta-analysis revealed nonsignificant differences in operative times, overall morbidity, major complications, blood transfusion, POPF, DGE, reoperation, and LOS. Alternatively, compared with LPD, RPD was associated with less blood loss (p = 0.002), less conversion rate (p < 0.00001), less vascular resection (p = 0.0006), and more retrieved lymph nodes (p = 0.01).ConclusionRPD is at least equivalent to LPD with respect to the incidence of complication, incidence and severity of DGE, and reoperation and length of hospital stay. Compared with LPD, RPD seems to be associated with less blood loss, lower conversion rate, less vascular resection, and more retrieved lymph nodes.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD2021274057

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“…Due to high costs, the application of these technologies is limited to a few large international centers, so that universally applied Standard Operating Procedures have not yet been established. Some studies also indicate that significant center-specific and time-dependent differences prevail, thus any benefits of robotic-assisted pancreatic surgery may develop only after extended learning curves [6][7][8][9]. However, company marketing and the general popularity of such technologies increase daily.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted pancreatic surgery—optimized operating procedures: set-up, port placement, surgical steps

et al. 2021

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Even in most complex surgical settings, recent advances in minimal-invasive technologies have made the application of robotic-assisted devices more viable. Due to ever increasing experience and expertise, many large international centers now offer robotic-assisted pancreatic surgery as a preferred alternative. In general however, pancreatic operations are still associated with high morbidity and mortality, while robotic-assisted techniques still require significant learning curves. As a prospective post-marketing trial, we have established optimized operating procedures at our clinic. This manuscript intends to publicize our standardized methodology, including pre-operative preparation, surgical set-up as well as the surgeons’ step-by-step actions when using pancreatic-assisted robotic surgery. This manuscript is based on our institutional experience as a high-volume pancreas operating center. We introduce novel concepts that should standardize, facilitate and economize the surgical steps in all types of robotic-assisted pancreatic surgery. The “One Fits All” principle enables single port placement irrespective of the pancreatic procedure, while the “Reversed 6-to-6 Approach” offers an optimized manual for pancreatic surgeons using the robotic console. Novel and standardized surgical concepts could guide new centers to establish a robust, efficient and safe robotic-assisted pancreatic surgery program.

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Perioperative Outcomes of Robotic Pancreaticoduodenectomy: a Propensity-Matched Analysis to Open and Laparoscopic Pancreaticoduodenectomy

Cited by 51 publications

References 36 publications

Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach

Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach

Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

Robot-assisted pancreatic surgery—optimized operating procedures: set-up, port placement, surgical steps

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