Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study

Chen, Shi; Zhan, Qimin; Chen, Jiang-Zhi; Jin, Jiabin; Deng, Xiaxing; Chen, Hao; Peng, Chenghong; Li, Hongwei

doi:10.1007/s00464-015-4101-5

Cited by 110 publications

(133 citation statements)

References 32 publications

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“…(42) Hence, based on the current evidence, we can only conclude that RDP is feasible and can be performed safely. (7,11,17) However, there is also growing evidence suggesting that RDP may be associated with a shorter learning curve, (15) a lower conversion rate (15) and an increased rate of splenic preservation (11,23,34,38,42) as compared to conventional laparoscopy. In a recent study by Kang et al from Yonsei University, Korea, the authors reported that the rate of splenic preservation was demonstrated a distended bowel with no transition point.…”

Section: Casementioning

confidence: 90%

“…(18) Although there has since been a growing number of RDP cases, the number of case series involving more than 15 patients that report on the outcome of RDP is limited (Table II). (11,17,(37)(38)(39)(40)(41)(42) The published case series are also limited to centres located in Italy, the United States, China and Korea. The first spleen-saving RDP in Korea was only reported recently in 2011.…”

Section: Casementioning

confidence: 99%

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First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases

Goh

Wong

Chan

et al. 2016

smedj

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INTRODUCTIONOver the past few decades, the use of laparoscopic surgery has expanded rapidly to become the surgical approach of choice for many abdominal operations, including cholecystectomies, (1) appendicectomies, (2) adrenalectomies,colectomies (4) and gastric resections.(5,6) However, the adoption of laparoscopic surgery in the fields of liver and pancreatic surgery has been relatively slow. (7,8) Although the first laparoscopic liver and pancreatic resections were reported in the early 1990s, (9,10) widespread adoption of such operations has been hindered by the technical complexities of these procedures, and concerns about oncological margins and risk of bleeding. (8) Pancreatic surgery is among the most complex and challenging of all abdominal operations.(11) Despite rapid surgical advancements, pancreatic surgery remains a challenge and is associated with a high morbidity rate worldwide, even in highly specialised and experienced tertiary centres.(12,13) Laparoscopic pancreatic surgery was first reported by Cuschieri in 1994.(9) Since then, a growing number of studies on laparoscopic pancreatic surgeries have been published, although it has yet to gain widespread acceptance.(11) As distal pancreatectomy (DP) is not as technically demanding as pancreaticoduodenectomy, it is not surprising that most of the published studies are on the outcomes of laparoscopic DP (LDP). (14) These early studies have reported the potential benefits of using the laparoscopic approach, including decreased pain and blood loss, faster recovery, and a shorter hospital stay; the laparoscopic approach is also associated with morbidity rates that are similar to those observed with the use of the open approach. (14,15) Despite the increased adoption of LDP, there are barriers to its widespread adoption, which include the significant risk of conversion to the hand-assisted or open approach. (15,16) Robotic surgery was introduced to overcome the shortcomings of conventional laparoscopic surgery. (11,15,17) The robotic platform provides a three-dimensional, high-definition, magnified view of the operative field. It also provides the additional advantages of improved dexterity and precision due to increased freedom of movement and the elimination of tremors. (7,11) The superiority of robotic surgery over conventional laparoscopy when performing complex surgical tasks has been proven in ex vivo models. (15) However, its use in the clinical setting remains controversial, especially with regard to DP. In the first series of robotic distal pancreatectomies (RDPs), reported by Giulianotti et al in 2003, 13 patients underwent RDP. (18) Several studies on RDP have since been reported, most of which were small case series involving less than 50 patients. (17)

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Section: Casementioning

confidence: 90%

Section: Casementioning

confidence: 99%

First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases

Goh

Wong

Chan

et al. 2016

smedj

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“…Moreover, the risk of developing gastric or esophageal varices and potential varices bleeding due to a portal hypertension is reduced by preserving the splenic vein [2,[9][10][11] . Since several authors reported serious problems like splenic infarctions or abscesses after the Warshaw procedure [12,13] , it is supposed that vessel-preserving spleen-preservation (SP) in DP is beneficial for patients with benign and borderline tumors [11,14,15] .…”

Section: Introductionmentioning

confidence: 99%

Robotic-Assisted Approach Improves Vessel Preservation in Spleen-Preserving Distal Pancreatectomy

et al. 2016

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Background: Vessel-preserving spleen preservation (SP) during distal pancreatectomy (DP) is supposed to be beneficial for patients with benign and borderline tumors. This study evaluated the first experiences with robotic-assisted laparoscopic DP (RA-LDP) and its rate of vessel preservation and SP compared to conventional laparoscopic DP (C-LDP). Methods: Patients scheduled for spleen-preserving DP for benign or borderline tumors by either C-LDP or RA-LDP were retrieved from a prospective database and retrospectively analyzed regarding vessel-preservation and SP, conversion rate, blood loss, operating time, complications, perioperative blood transfusion, postoperative hospital stay (PHS) and mortality. Results: Twenty-nine patients underwent C-LDP and 12 patients underwent RA-LDP between September 2009 and May 2015. SP rates were 79% (23 of 29) in the C-LDP and 92% (11 of 12) in the RA-LDP group (p = 0.32). Splenic vessels could be preserved in 17% (5 of 29) of the C-LDP and 50% (6 of 12) of the RA-LDP group (p = 0.052). Operating time, intraoperative blood loss, the number of perioperative red blood cell transfusions, overall morbidity and the rate of postoperative pancreatic fistulas were not different between the groups. PHS was shorter in the RA-LDP group (10.5 vs. 13 days; p = 0.02). Conclusion: RA-LDP for benign or borderline tumors of the pancreas is a safe procedure and tended to be associated with a better vessel-preservation rate, thereby making it a good alternative to C-LDP.

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“…In spleen preserving techniques where pancreatic branches from the splenic vein and artery are individually ligated and sutured (splenic vessel preservation), robotic surgical systems increase the likelihood of successful splenic preservation compared to traditional laparoscopy (2,3). This effect can be explained by the impact of the robotic instrument articulation providing greater needle dexterity which is critical in ligating small venous or arterial branches along the relatively thin-walled splenic vein.…”

Section: Rationalementioning

confidence: 99%

“…A majority of surgeons had utilized laparoscopic techniques for minimally invasive distal pancreatectomy prior to the advent of modern robotic surgical systems. In contrast to traditional laparoscopy, robotic distal pancreatectomy has been shown to be feasible in performing both standard and more complex resections with greater technical demands (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Robotic distal pancreatectomy and splenectomy: rationale and technical considerations

Royall

Walsh

2017

J. Vis. Surg.

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Minimally invasive distal pancreatectomy has had significant adoption in the United States over the past decade. Robotic distal pancreatectomy is a type of minimally invasive technique which affords greater dexterity and visualization compared to traditional laparoscopy. In addition to standard distal pancreatectomy procedures with or without splenectomy, the use of robotic surgical systems has been efficacious in performing more complex techniques such as radical antegrade modular pancreatosplenectomy (RAMPS) or spleen-preservation. There are important technical considerations to performing robotic distal pancreatectomy procedures which differ from other minimally invasive approaches. The purpose of this report is to describe the rationale and technical considerations for implementation of robotic distal pancreatectomy procedures in clinical practice.

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Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study

Abstract: RA-LDP was associated with a significantly better SP rate and reduced OT, blood loss, transfusion requirement, and PHS for patients undergoing SP compared to C-LDP, but offered less benefits for patients undergoing splenectomy.

Cited by 110 publications

References 32 publications

First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases

First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases

Robotic-Assisted Approach Improves Vessel Preservation in Spleen-Preserving Distal Pancreatectomy

Robotic distal pancreatectomy and splenectomy: rationale and technical considerations

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