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

Abstract

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.

Repeated robotic pancreatectomy for recurrent pancreatic metastasis of mesenchymal chondrosarcoma: A case report

“…Robotic surgery provides additional advantages over laparoscopic surgery, including high‐resolution three‐dimensional visualization, precise tissue manipulation with articulated forceps, and tremor filtration. A meta‐analysis has suggested that robotic pancreatectomy is associated with better perioperative outcomes, including a lower conversion rate, less estimated blood loss, and more lymph node retrieval, than laparoscopic pancreatectomy 9,10 . The present report is the first to discuss repeated robotic pancreatectomies for malignancy with no problematic postoperative clinical course.…”

“…A metaanalysis has suggested that robotic pancreatectomy is associated with better perioperative outcomes, including a lower conversion rate, less estimated blood loss, and more lymph node retrieval, than laparoscopic pancreatectomy. 9,10 The present report is the first to discuss repeated robotic pancreatectomies for malignancy with no problematic postoperative clinical course. We believe that the contribution of robotic surgery was prominent, especially in the second pancreatectomy.…”

Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

“…Of the 21 patients who received conversion to open surgery, the reasons were as follows: intraoperative bleeding (9), dense adhesions (2), tumour extension to other organs (5), tumour proximity to SMV/PV (2), and vascular invasion (3). Intraoperative adverse events (bleeding leading to emergency conversion in all cases) occurred more frequently in the LDP versus RDP group (7 [15.9%] vs. 2 [5.4%] patients, p = 0.118).…”

“…Minimally invasive distal pancreatectomy (MIDP), including robotic (RDP) and laparoscopic (LDP) approaches, has been well adopted as a safe option in selected patients undergoing left pancreatectomy. 1,2 The recently published DIPLOMA study, a prospective randomized trial comparing open distal pancreatectomy (ODP) with MIDP in patients with pancreatic ductal adenocarcinoma (PDAC), showed that MIDP was non-inferior to OPD in terms of long-term oncological outcomes. 3 When comparing approaches in MIDP, several retrospective studies demonstrated that RDP and LDP have similar rates of major complications.…”

“…3 When comparing approaches in MIDP, several retrospective studies demonstrated that RDP and LDP have similar rates of major complications. 2,4 Despite these results, RDP is associated with a lower rate of conversion to open surgery and less blood loss compared with LDP 5,6 to the detriment of longer operative time and hospital stay. 5 Although the robotic approach seems to outperform in technically challenging cases, no previous studies have demonstrated any difference in postoperative complications.…”