Robotic pancreaticoduodenectomy

Abstract

Pancreaticoduodenectomy (PD) is considered one of the most complex and technically challenging abdominal surgeries performed by general surgeons. With increasing use of minimally invasive surgery, this operation continues to be performed most commonly in an open fashion. Open PD (OPD) is characterized by high morbidity and mortality rates in published series. Since the early 2000s, use of robotics for PD has slowly evolved. For appropriately selected patients, robotic PD (RPD) has been shown to have less intraoperative blood loss, decreased morbidity and mortality, shorter hospital length of stay, and similar oncological outcomes compared with OPD. At our high-volume center, we have found lower complication rates for RPD along with no difference in total cost when compared with OPD. With demonstrated noninferior oncologic outcomes for RPD, the potential exists that RPD may be the future standard in surgical management for pancreatic disease. We present a case of a patient with a pancreatic head mass and describe our institution's surgical technique for RPD.

A Potential Role for Robotic Cholecystectomy in Patients with Advanced Liver Disease: Analysis of the NSQIP Database

“…They also concluded that RC seemed to be a safe and feasible procedure, although more costly in comparison with LC. 7 Not surprisingly, our study confirmed that OC was associated with a longer hospital LOS and postoperative complications across all MELD groups. This is well documented in the literature.…”

“…This is well documented in the literature. [7][8][9]11 Similarly, Dolejs et al 5 demonstrated that patients undergoing OC had higher rates of mortality and morbidity across all MELD scores than those undergoing LC. It is likely that this is amplified in patients with higher MELDs, and thus explains the higher rate of postoperative complications observed in these patients in our study.…”

“…6 Several studies have highlighted the role of robotic surgery in hepatobiliary surgery including robotic liver resection, and pancreatic resections including Whipple procedure. 7,8 However, the role of robotic surgery in cholecystitis, especially in cirrhotic patients, is not well defined in the literature. RC has not gained widespread acceptance in part because of the potential for increased operative time and higher cost, with no clear advantage over LC in terms of clinical outcomes.…”

Robotic pancreaticoduodenectomy and splenopancreatectomy: technical aspects and review of literature

“…At our high-volume center, we have performed more than 180 robotic PDs since 2012 and over 200 distal pancreatectomies with splenectomy (DPS) since 2008. We have found lower complication rates for robotic PD along with no differences in total costs when compared with the open PD, but more importantly, robotic PD may offer improved oncologic outcomes [3,4] .…”

“…The falciform ligament is taken down and to be used as a vascularized pedicled flap [3] . To optimize surgical exposure of the hepatoduodenal ligament, the gallbladder is sutured to the anterior abdominal wall.…”