Robotic Distal Pancreatectomy

Müller, Philip; Breuer, Eva; Nickel, Felix; Zani, Sabino; Kauffmann, Emanuele Federico; Franco, Lorenzo; Tschuor, Christoph; Krohn, Paul Suno; Burgdorf, Stefan Kobbelgaard; Jonas, Jan Philipp; Oberkofler, Christian E.; Petrowsky, Henrik; Saint‐Marc, Olivier; Seelen, Leonard W. F.; Molenaar, I.; Wellner, Ulrich F.; Keck, Tobias; Coratti, Andrea; Dam, Coen van; Wilde, Roeland de; Koerkamp, B. Groot; Valle, Valentina; Giulianotti, Pier Cristoforo; Ghabi, Elie; Moskal, David; Lavu, Harish; Vrochides, Dionisios; Martinie, John B.; Yeo, Charles J.; Sánchez-Velázquez, Patricia; Ielpo, Benedetto; Ajay, Pranay S.; Shah, Mihir M.; Kooby, David A.; Gao, Song; Hao, Jihui; He, Jing; Boggi, Ugo; Hackert, Thilo; Allen, Peter J.; Borel-Rinkes, Inne H. M.; Clavien, Pierre Alain

doi:10.1097/sla.0000000000005601

Cited by 31 publications

(18 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Meanwhile, adequate case selection with regards to favourable anatomical (low BMI) and disease specific (no vessel involvement) features in a first learning phase under supervision to reach competency level seems of paramount importance. With increasing experience, proficiency and mastery levels are reached and more complex procedures may be introduced with the goal to achieve benchmark outcomes 28 , 38 . Furthermore, several initiatives for collaborative research on safe implementation of the minimally invasive technique in pancreatic surgery, such as the European Consortium of Minimally Invasive Pancreatic Surgery (E-MIPS), have emerged 39 , 40 .…”

Section: Discussionmentioning

confidence: 99%

“… 6 , postoperative safety outcomes from the current meta-analysis appear within benchmark cut-offs. Recently published analyses further report benchmark criteria for minimally invasive and open DP 38 , 43 , 44 . Benchmark cut-off values for mortality rate in PD were set at less than or equal to 1.6 per cent and 2 per cent by Sánchez-Velázquez et al .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

et al. 2023

View full text Add to dashboard Cite

Background Widespread implementation of the minimally invasive technique in pancreatic surgery has proven to be challenging. The aim of this study was to compare the perioperative outcomes of minimally invasive (laparoscopic and robotic) pancreatic surgery with open pancreatic surgery using data obtained from RCTs. Methods A literature search was done using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Web of Science; all available RCTs comparing minimally invasive pancreatic surgery and open pancreatic surgery in adults requiring elective distal pancreatectomy or partial pancreatoduodenectomy were included. Outcomes were mortality rate, general and pancreatic surgery specific morbidity rate, and length of hospital stay. Results Six RCTs with 984 patients were included; 99.0 per cent (486) of minimally invasive procedures were performed laparoscopically and 1.0 per cent (five) robotically. In minimally invasive pancreatic surgery, length of hospital stay (−1.3 days, −2 to −0.5, P = 0.001) and intraoperative blood loss (−137 ml, −182 to −92, P < 0.001) were reduced. In the subgroup analysis, reduction in length of hospital stay was only present for minimally invasive distal pancreatectomy (−2 days, −2.3 to −1.7, P < 0.001). A minimally invasive approach showed reductions in surgical site infections (OR 0.4, 0.1 to 0.96, P = 0.040) and intraoperative blood loss (−131 ml, −173 to −89, P < 0.001) with a 75 min longer duration of surgery (42 to 108 min, P < 0.001) only in partial pancreatoduodenectomy. No significant differences were found with regards to mortality rate and postoperative complications. Conclusion This meta-analysis presents level 1 evidence of reduced length of hospital stay and intraoperative blood loss in minimally invasive pancreatic surgery compared with open pancreatic surgery. Morbidity rate and mortality rate were comparable, but longer duration of surgery in minimally invasive partial pancreatoduodenectomy hints that this technique in partial pancreatoduodenectomy is technically more challenging than in distal pancreatectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Recently, several studies based on the data analysis of multicentre and large-scale studies reported the benchmark values of MIDP to identify the best achievable results and define optimal perioperative outcomes, with the intention of assessing and enhancing the surgery quality [ 65 , 66 ]. Muller et al [ 66 ] reported that benchmark values of RDP included: operation time ≤ 300 min, estimated blood loss ≤ 150 ml, conversion rate ≤ 3%, major complication rate ≤ 26.7%, clinical pancreatic fistula rate ≤ 32%, lymph node retrieval for PADC ≥ 9, and R0 resection rate for PDAC ≥ 83%. In the majority of the included studies, there was a disparity between the outcomes and the benchmark values.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic distal pancreatectomy on perioperative outcomes: a systematic review and meta-analysis

Zhang

Chen

et al. 2022

Updates Surg

View full text Add to dashboard Cite

Robotic surgery has become a promising surgical method in minimally invasive pancreatic surgery due to its three-dimensional visualization, tremor filtration, motion scaling, and better ergonomics. Numerous studies have explored the benefits of RDP over LDP in terms of perioperative safety and feasibility, but no consensus has been achieved yet. This article aimed to evaluate the benefits and drawbacks of RDP and LDP for perioperative outcomes. By June 2022, all studies comparing RDP to LDP in the PubMed, the Embase, and the Cochrane Library database were systematically reviewed. According to the heterogeneity, fix or random-effects models were used for the meta-analysis of perioperative outcomes. Odds ratio (OR), weighted mean differences (WMD), and 95% confidence intervals (CI) were calculated. A sensitivity analysis was performed to explore potential sources of high heterogeneity and a trim and fill analysis was used to evaluate the impact of publication bias on the pooled results. Thirty-four studies met the inclusion criteria. RDP provides greater benefit than LDP for higher spleen preservation (OR 3.52 95% CI 2.62–4.73, p < 0.0001) and Kimura method (OR 1.93, 95% CI 1.42–2.62, p < 0.0001) in benign and low-grade malignant tumors. RDP is associated with lower conversion to laparotomy (OR 0.41, 95% CI 0.33–0.52, p < 0.00001), and shorter postoperative hospital stay (WMD − 0.57, 95% CI − 0.92 to − 0.21, p = 0.002), but it is more costly. In terms of postoperative complications, there was no difference between RDP and LDP except for 30-day mortality (RDP versus LDP, 0.1% versus 1.0%, p = 0.03). With the exception of its high cost, RDP appears to outperform LDP on perioperative outcomes and is technologically feasible and safe. High-quality prospective randomized controlled trials are advised for further confirmation as the quality of the evidence now is not high.

show abstract

“…18 The research group of Clavien et al introduced the notion of global outcome benchmarks, where procedure-specific outcome goals are set for a list of clinically relevant quality indicators (QIs), based on the 75th percentile of the outcomes obtained in international high-volume centers. 11,13,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] Global outcome benchmarks have been so far established for minimally invasive esophagectomy, 25 liver surgery, 26 liver transplantation, 24,31 ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), 22 pancreatic surgery, 20,23 colorectal resections, 32 as well as for bariatric surgery 19,21 (►Table 1). Meanwhile, Kolfschoten et al developed a composite outcome measure representing the percentage of patients with textbook outcomes, meaning that all desired health outcomes are reached simultaneously.…”

Section: Ideal Surgical Outcomesmentioning

confidence: 99%

Classification of Adverse Events in Adult Surgery

2023

View full text Add to dashboard Cite

Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien–Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.

show abstract

Robotic Distal Pancreatectomy

Cited by 31 publications

References 55 publications

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

Robotic versus laparoscopic distal pancreatectomy on perioperative outcomes: a systematic review and meta-analysis

Classification of Adverse Events in Adult Surgery

Contact Info

Product

Resources

About