Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Abstract

Background An increasing body of literature is supporting the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy, but there are limited comparative studies between laparoscopic and robotic pancreaticoduodenectomy. The aim of this study was to compare the rate of postoperative 30-day overall complications between laparoscopic and robotic pancreaticoduodenectomy. Methods Patients who underwent laparoscopic and robotic pancreaticoduodenectomy were abstracted from the 2014–2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. A multivariable logistic regression model was developed to determine if the type of minimally invasive approach was associated with 30-day overall complications. Results We identified 428 minimally invasive pancreaticoduodenectomy cases, of which 235 (55%) were performed laparoscopically and 193 (45%) robotically. Patients who underwent the robotic approach were more likely to be white compared to those who underwent laparoscopic, and less likely to have pulmonary disease, undergo preoperative radiotherapy, and have vascular and multivisceral resection. On multivariable analysis, we found that the type of minimally invasive approach, whether laparoscopic or robotic, was not associated with overall complications. The predictors of 30-day overall complications were higher body mass index (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02–1.09), vascular resection (OR, 2.10; 95% CI, 1.23–3.58), and longer operative time (OR, 1.002; 95% CI, 1.001–1.004). Conclusions Robotic pancreaticoduodenectomy was associated with a similar 30-day overall complication rate to laparoscopic pancreaticoduodenectomy. Further studies are needed to corroborate these findings and to establish the best approach to perform this complex operation.

Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases

“…In a recent North American multicentre database study, RPS was found to be associated with a lower open conversion rate compared to LPS for both PD and DP . There was no difference in the overall morbidity rate of RPD compared to LPD . Another multicentre study from the United States demonstrated that RPD could be adopted safely with similar overall and anastomotic complications compared to the open approach even during the early learning phase .…”

Minimally invasive pancreatic surgery—where are we going?

“…The review of the American College of Surgeons National Surgical Quality Improvement Program database found that the type of MIPD (laparoscopic or robotic) was not associated with postoperative complications [53]. Another similar study from Zimmerman et al found that robotic surgery was less frequently performed for malignancies and was associated with more surgical site infections, but a lower conversion rate compared with laparoscopy [54].…”

Robotergestützte Bauchspeicheldrüsenchirurgie

“…Ein Review des American College of Surgeons National Surgical Quality Improvement Program (NSQIP) zeigt, dass weder die laparoskopische noch auch die robotisch assistierte Pankreatoduodenektomie mit einer erhöhten Rate an postoperativen Komplikationen einhergehen [21].…”