Robotic‐assisted pancreatic surgery

Abstract

Background Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. Methods As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. Results Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. Conclusion Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short-and long-term outcomes seem to be similar to the ones achieved in open surgery.

Comparison of surgical outcomes between open and robot‐assisted minimally invasive pancreaticoduodenectomy

“…It is debatable whether the superior approach for PD is totally robotic surgery or laparoscopic/robotic hybrid surgery. Fernandes et al reported that a totally robotic approach was superior, whereas other studies reported that a hybrid laparoscopic and robotic approach consisting of laparoscopic dissection and robotic reconstruction was superior . The present study used a hybrid approach; laparoscopic surgery enabled a prompt response and wide range of motion during the dissection phase, while robotic surgery enabled fixed and fine movement during the anastomosis phase.…”

Initial Experience With Robotic Pancreatic Surgery

“…3 These findings were not confirmed in a meta-analysis of 9 nonrandomized studies comparing open and minimally invasive (both laparoscopic and robotic) PD, where the time disparity in favor of open PD was attributed to the laparoscopic approach. 20 In our series, the operative time of robot-assisted PD did not decrease with increasing experience, probably due to a contemporary increase in the complexity of the cases and a reduction in the conversion rate.…”

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Pankreas - Pro-Position

“…Verschiedene Gruppen haben in den letzten Jahren Ergebnisse zur roboterassistierten Pankreaschirurgie veröffentlicht. Die bisher größte Fallserie umfasst 134 Patienten (60 Pankreatikoduodenektomien, 46 Pankreaslinksresektionen sowie 3 zentrale Resektionen und eine totale Pankreatektomie) [37,38]. In einer vergleichenden Analyse war die roboterassistierte Pankreaslinksresektion mit einer deutlich längeren Operationsdauer und erheblich höheren Kosten als bei der konventionellen laparoskopischen Pankreaslinksresektion verbunden [39].…”

“…Auch die roboterassistierten Pankreatikoduodenektomien scheinen mit ähnlichen Ergebnissen einherzugehen wie die laparoskopischen Pankreatikoduodenektomien - bei deutlich höheren Kosten und einer längeren Operationsdauer [8]. Die grundsätzliche Machbarkeit konnte jedoch in verschiedenen Serien gezeigt werden [37,41,42]. Eine kürzlich veröffentlichte Metaanalyse bestätigte die Machbarkeit der roboterassistierten Pankreaschirurgie ohne Nachteile bezüglich der perioperativen oder onkologischen Qualität [43].…”