Robotic Pancreaticoduodenectomy Is the Future: Here and Now

Rosemurgy, Alexander S.; Ross, Sharona; Bourdeau, Timothy J.; Craigg, Danielle; Spence, Janelle; Alvior, Joshua; Sucandy, Iswanto

doi:10.1016/j.jamcollsurg.2018.12.040

Cited by 39 publications

(28 citation statements)

References 16 publications

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“…The vast majority of the indications for PD are malignant tumors located in the periampullary region and the head of the pancreas. Only a small percentage of the performed procedures are because of nonmalignant neoplastic diseases and chronic pancreatitis [24][25][26].…”

Section: Pancreatic Surgerymentioning

confidence: 99%

Minimally invasive pancreatic surgery—will robotic surgery be the future?

et al. 2021

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SummaryDue to the complexity of the procedures and the texture of the organ itself, pancreatic surgery remains a challenge in the field of visceral surgery. During the past decade, a minimally invasive approach to pancreatic surgery has gained distribution in clinical routine, extending from left-sided procedures to pancreatic head resections. While a laparoscopic approach has proven beneficial for many patients with left-sided pancreatic pathologies, the complex reconstruction in pancreas head resections remains worrisome with the laparoscopic approach. The robotic technique was established to overcome such technical constraints while preserving the advantages of the laparoscopic approach. Even though robotic systems are still in development, especially in pancreatoduodenectomy, the current literature demonstrates the feasibility of this approach and stable clinical and oncological outcomes compared to the open technique, albeit only under the condition of such operations being performed by specialist teams in a high-volume setting (>20 robotic pancreaticoduodenectomies per year). The aim of this review is to analyze the current evidence regarding a minimally invasive approach to pancreatic surgery and to review the potential of a robotic approach. Presently, there is still a scarcity of sound evidence and long-term oncological data regarding the role of minimally invasive and robotic pancreatic surgery in the literature, especially in the setting of pancreaticoduodenectomy.

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Section: Pancreatic Surgerymentioning

confidence: 99%

Minimally invasive pancreatic surgery—will robotic surgery be the future?

et al. 2021

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“…11 We have previously reported that our patients had fewer complications than reported within NSQIP, and this group of patients looked like those previously reported. 3 Complications were relatively uncommon, occurring in fewer than 1 of 5 patients, and were generally not serious, with only 1 of 3 patients with a complication having a complication of grade 3 or greater; this means that less than 1 in 15 patients had a complication of grade 3 or greater. Unlike some other studies, pancreatic and/or biliary leaks were more common after robotic pancreaticoduodenectomy, but were low when considering the experience of most other authors.…”

Section: Discussionmentioning

confidence: 98%

“…Conversions to "open" pancreaticoduodenectomy were more prevalent in our earlier experience, but they still occur. 3 Conversions were included in our analyses of robotic pancreaticoduodenectomy on an intention-to-treat basis. This inclusion didn't change our conclusions, as their numbers were relatively small.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Pancreaticoduodenectomy at a High-Volume Robotic Hepatopancreaticobiliary Surgery Program

Rosemurgy

Ross

Bourdeau

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND:The robotic approach to pancreaticoduodenectomy is thought by many to be associated with increased financial burden for hospitals. We undertook this study to analyze and compare the cost of "open" pancreaticoduodenectomy with that associated with the application of the robotic surgical system to pancreaticoduodenectomy in our hepatobiliary program. STUDY DESIGN: With IRB approval, all patients undergoing pancreaticoduodenectomy at our institution, from August 2012 to November 2019, were prospectively followed. Cost, including total, variable, fixed-direct, fixed-indirect, and profitability for robotic and "open" pancreaticoduodenectomy were analyzed and compared. Data are presented as median (mean AE SD). RESULTS:There were 386 patients who underwent pancreaticoduodenectomy; 205 patients underwent robotic pancreaticoduodenectomy and 181 underwent "open" pancreaticoduodenectomy. Costs are presented as mean AE SD.

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“…Applied to procedures currently performed predominantly laparoscopically, robotic surgery may improve surgeon ergonomics and offers technical advantages in visualization and dexterity. Robotic technology has enabled the evolution of minimally invasive techniques that allow its application to traditionally open procedures such as retromuscular abdominal wall reconstruction 9,10 and pancreaticoduodenectomy, 11 and even novel techniques such as extended-view totally extraperitoneal repair of ventral incisional hernias. 12 However, clinical data necessarily lags behind adoption of a new technology.…”

Section: Discussionmentioning

confidence: 99%

Robotic Versus Laparoscopic Approach to Hiatal Hernia Repair: Results After 7 Years of Robotic Experience

O’Connor

Mallard

Desai

et al. 2020

The American Surgeon

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Introduction Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs. Methods A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher’s exact test. Continuous variables were analyzed with Student’s t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software. Results Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001). Discussion Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.

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Robotic Pancreaticoduodenectomy Is the Future: Here and Now

Cited by 39 publications

References 16 publications

Minimally invasive pancreatic surgery—will robotic surgery be the future?

Minimally invasive pancreatic surgery—will robotic surgery be the future?

Cost Analysis of Pancreaticoduodenectomy at a High-Volume Robotic Hepatopancreaticobiliary Surgery Program

Robotic Versus Laparoscopic Approach to Hiatal Hernia Repair: Results After 7 Years of Robotic Experience

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