Robotic and open pancreaticoduodenectomy: results from Taipei Veterans General Hospital in Taiwan

Shyr, Bor‐Uei; Shyr, Bor‐Shiuan; Chen, Shih‐Chin; Shyr, Yi‐Ming; Wang, Shin‐E

doi:10.1007/s13304-020-00899-z

Cited by 16 publications

(15 citation statements)

References 25 publications

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“…Regarding the effect of minimally invasive PD on DGE development, the findings are inconclusive. National registries [ 37 ] and meta-analyses [ 38 , 39 ] were not able to detect an effect, single-center studies showed different results ( 40 , 41 ). Robotic PD was introduced in our department several years ago, but because its use does not span the whole period, we did not include minimally invasive PD into our analysis.…”

Section: Discussionmentioning

confidence: 99%

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

et al. 2021

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Background Delayed gastric emptying (DGE) is the most common complication following pancreatoduodenectomy (PD). The data about active smoking in relation to gastric motility have been inconsistent and specifically the effect of smoking on gastric emptying after PD has not yet been investigated in detail. Methods 295 patients at our department underwent PD between January 2009 and December 2019. Patients were analyzed in relation to demographic factors, diagnosis, pre-existing conditions, intraoperative characteristics, hospital stay, mortality and postoperative complications with special emphasis on DGE. All complications were classified according to the definitions of the International Study Group on Pancreatic Surgery. Results 274 patients were included in the study and analyzed regarding their smoking habits (non or former smokers, n = 88, 32.1% vs. active smokers, n = 186, 68.6%). Excluded were patients for whom no information about their smoking habits was available (n = 3), patients who had had gastric resection before (n = 4) and patients with prolonged postoperative resumption to normal diet independently from DGE (long-term ventilation > 7 days, fasting due to pancreatic fistula) (n = 14). Smokers were younger than non-smokers (61 vs. 69 years, p ≤ 0.001) and mainly male (73% male vs. 27% female). Smoking patients showed significantly more pre-existing pulmonary conditions (19% vs. 8%, p = 0.002) and alcohol abuse (48% vs. 23%, p ≤ 0.001). We observe more blood loss in smokers (800 [500–1237.5] vs. 600 [400–1000], p = 0.039), however administration of erythrocyte concentrates did not differ between both groups (0 [0–2] vs. 0 [0–2], p = 0.501). 58 out of 88 smokers (66%) and 147 out of 186 of non-smokers (79%) showed malign tumors (p = 0.019). 35 out of 88 active smokers (40%) and 98 out of 188 non- or former smokers (53%) developed DGE after surgery (p = 0.046) and smokers tolerated solid food intake more quickly than non-smokers (postoperative day (POD7 vs. POD10, p = 0.004). Active smokers were less at risk to develop DGE (p = 0.051) whereas patients with pulmonary preexisting conditions were at higher risk for developing DGE (p = 0.011). Conclusions Our data show that DGE occurs less common in active smokers and they tolerate solid food intake more quickly than non-smokers. Further observation studies and randomized, controlled multicentre studies without the deleterious effect of smoking, for instance by administration of a nicotine patch, are needed to examine if this effect is due to nicotine administration.

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Section: Discussionmentioning

confidence: 99%

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

et al. 2021

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“…It has been claimed that RPD has benefits of less delayed gastric emptying, less blood loss, lower wound infection rate, and shorter postoperative hospital stay, as compared with OPD, according to studies and literature reports. 1 , 5 , 7 , 8 , 9 , 26 , 27 , 28 , 29 Our study showed that the biggest complications after RPD are 18.1% occurrence of chyle leakage, followed by 5.7% occurrence of postoperative pancreatic fistula, 4.8% occurrence of intra‐abdominal abscess, 3.8% occurrence of delayed gastric emptying, and post pancreatectomy hemorrhage. 2 The wounds after RPD and OPD are shown in Figure 5 .…”

Section: Surgical Outcomes After Robotic Pancreaticoduodenectomymentioning

confidence: 63%

“… 7 For ampullary cancer, there is no survival difference between RPD and OPD groups (Figure 7 ). 7 At least, RPD is not only technically feasible but also oncologically justifiable without compromising the survival outcomes of pancreatic head and ampullary cancers, although selection bias would be inevitable in this retrospective study. 1 , 2 , 9 Prospective randomized control trials or studies of larger sample sizes with long‐term follow‐up are recommended to reach a reliable conclusion.…”

Section: Survival Outcomes After Robotic Pancreaticoduodenectomymentioning

confidence: 94%

“…The pancreas team led by Y. M. Shyr and S. E. Wang at Taipei Veterans General Hospital have been endeavoring to develop robotic pancreaticoduodenectomy (RPD) since 2014. 6 With the experience of more than 1580 cases of pancreaticoduodenectomy and over 375 cases of RPD (Figure 1 ), some remarkable results have been achieved in RPD, 7 , 8 , 9 including: (a) shorter hospital stay after RPD, as early as on post‐operative day 6 in five cases of RPD; (b) better cosmesis and smaller wounds, as small as 3 ~ 4 cm by RPD, about 1/10 of the 30 ~ 40 cm wounds by traditional OPD; (c) nearly “no” blood loss in four cases of RPD, with a mean of 120‐150 c.c., as compared to 250‐500 c.c. blood loss by traditional OPD; (d) short operation time by RPD, as short as 232 minutes.…”

Section: Introductionmentioning

confidence: 99%

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Robotic pancreaticoduodenectomy for pancreatic head cancer and periampullary lesions

Shyr

Wang

Chen

et al. 2021

Annals of Gastroent Surgery

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Pancreaticoduodenectomy, so‐called “Whipple operation,” is a time‐consuming and technically demanding complex operation. Traditionally, this procedure has been performed most usually by open approach, which results in a large and painful wound. With the introduction of laparoscopic and robotic surgery, minimally invasive surgery (MIS) has emerged as a worldwide trend to improve wound cosmesis and to minimize wound pain. Although MIS for pancreaticoduodenectomy has also been attempted at some centers, the role of MIS, either robotic or laparoscopic approach, has not been well‐established for complex pancreaticoduodenectomy. Given that laparoscopic pancreaticoduodenectomy has been limited by its technical complexity and the high level of advanced laparoscopic skills required for pancreatic reconstruction, a robotic surgical system is introduced to overcome several limitations related to the laparoscopic approach. Providing high‐quality three‐dimensional (3‐D) vision, high optical magnification, articulation of robotic instruments, greater precision with suture targeting, and elimination of surgeon tremor, robotic surgical systems innovatively perform more delicate and complex procedures involving extensive dissection and suturing techniques such as pancreaticoduodenectomy. Although associated with longer operative time, robotic pancreaticoduodenectomy (RPD) has been claimed to have the benefits of less delayed gastric emptying, less blood loss, shorter length of postoperative stay, and lower wound infection rate, as compared with the traditional open pancreaticoduodenectomy (OPD). Moreover, RPD seems to be not only technically feasible but also justified without compromising the survival outcomes for pancreatic head and ampullary adenocarcinomas. Therefore, RPD could be recommended not only to surgeons but also to patients in terms of surgical feasibility, surgical outcomes, and patient satisfaction.

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“…Extended paper revision led to the final inclusion of 21 studies, for a total of 4,448 patients (Figure 1). This meta-analysis includes three randomized trials (7,12,13) and two prospective studies (14,15). In the remaining papers, data were retrieved in a retrospective fashion: we included 9 retrospective reviews (16-24); 7 casecontrol matched analysis (25-31): of those, four performed a propensity score analysis (25,26,28,29).…”

Section: Resultsmentioning

confidence: 99%

Postoperative Pancreatic Fistula: Is Minimally Invasive Surgery Better than Open? A Systematic Review and Meta-analysis

et al. 2022

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Background/Aim: Minimally invasive pancreaticoduodenectomy (PD) is gaining popularity. The aim of this study was to compare the incidence of postoperative pancreatic fistula (POPF) after minimally invasive versus open procedures. Materials and Methods: Following the PRISMA statement, literature research was conducted focusing on papers comparing the incidence of POPF after open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD).Results: Twenty-one papers were included in this metaanalysis, for a total of 4,448 patients. A total of 2,456 patients (55.2%) underwent OPD, while 1,992 (44.8%) underwent MIPD. Age, ASA score III patients, incidence of pancreatic ductal adenocarcinoma and duct diameter were significantly lower in the MIPD group. No statistically significant differences were found between the OPD and MIPD regarding the incidence of major complications (15.6% vs. 17.0%, respectively, p=0.55), mortality (3.7% vs. 2.4%, p=0.81), and POPF rate (14.3% vs. 12.9%, p=0.25). Conclusion: MIPD and OPD had comparable rates of postoperative complications, postoperative mortality, and POPF.

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Robotic and open pancreaticoduodenectomy: results from Taipei Veterans General Hospital in Taiwan

Cited by 16 publications

References 25 publications

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

Robotic pancreaticoduodenectomy for pancreatic head cancer and periampullary lesions

Postoperative Pancreatic Fistula: Is Minimally Invasive Surgery Better than Open? A Systematic Review and Meta-analysis

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