Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution

Buchs, Nicolas; Addeo, Pietro; Bianco, Francesco M.; Ayloo, Subhashini; Benedetti, Enrico; Giulianotti, Pier Cristoforo

doi:10.1007/s00268-011-1276-3

Cited by 182 publications

(143 citation statements)

References 47 publications

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“…El sellado del remanente pancreático sin realizar anastomosis pancreático-entérica fue inicialmente descrito por Whipple en 1935 (29) y posteriormente se ha utilizado en múltiples ocasiones, sobre todo en pacientes afectos por pancreatitis crónica o en situaciones quirúrgicas de alto riesgo (30)(31)(32)(33)(34). Por lo que concierne a la insuficiencia pancreática exocrina varios estudios clínicos (35)(36) han demostrado que, en un porcentaje de casos muy elevados, las anastomosis pancreato-intestinales en las DPC no son funcionantes pocos meses después de la cirugía y existe insuficiencia pancreática exocrina en más del 50% de los pacientes intervenidos, siendo del 68% en los casos operados por cáncer de páncreas (37).…”

Section: Sellado Del Remanente Pancreático Como Alternativa a Su Anasunclassified

“…Por lo que concierne a la insuficiencia pancreática exocrina varios estudios clínicos (35)(36) han demostrado que, en un porcentaje de casos muy elevados, las anastomosis pancreato-intestinales en las DPC no son funcionantes pocos meses después de la cirugía y existe insuficiencia pancreática exocrina en más del 50% de los pacientes intervenidos, siendo del 68% en los casos operados por cáncer de páncreas (37). Aunque algunos autores la han utilizado como la técnica estándar en la DPC (33)(34), por el momento, su uso parece más racional en pacientes de elevado riesgo de dehiscencia anastomóstica como son los que tienen un páncreas blando y un conducto Wirsung fino, donde está demostrado que la incidencia de fístula pancreática es significativamente mayor (10,28). En la actualidad existen dispositivos de sellado eficiente del páncreas utilizando métodos de termocoagulación por radiofrecuencia (38) por lo cual estaría justificado su uso en estas situaciones en la práctica clínica.…”

Section: Sellado Del Remanente Pancreático Como Alternativa a Su Anasunclassified

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PADULAP study: To compare postoperative and pathologic results between open and laparoscopic approach for pancreaticoduodenectomy

Prim¹

2013

http://isrctn.org/>

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Section: Sellado Del Remanente Pancreático Como Alternativa a Su Anasunclassified

PADULAP study: To compare postoperative and pathologic results between open and laparoscopic approach for pancreaticoduodenectomy

Prim¹

2013

http://isrctn.org/>

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“…Even through retrospective series, RAPD appears to have better short-term outcomes compared to open and conventional laparoscopic surgery [13,16,[20][21][22][23]. However, there is still no consensus on how RAPD compares to pure laparoscopic PD.…”

Section: Robotic-assisted Pancreato-duodenectomymentioning

confidence: 99%

“…We have previously published the results of a study performed in the United States comparing open and robotic-assisted PD, demonstrating that the robotic platform had similar outcomes in term of morbidity and mortality compared to open surgery and also significant advantages in terms of blood loss and lymph node yield [13]. Our overall experience, however, currently amounts to more than 100 RAPDs (Giulianotti, personal communication to Clinical Robotics Surgical Association, CRSA 2012).…”

Section: Robotic-assisted Pancreato-duodenectomymentioning

confidence: 99%

Robotic‐assisted pancreatic surgery

Fernandes

Giulianotti

2013

J Hepato Biliary Pancreat

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Background Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. Methods As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. Results Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. Conclusion Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short-and long-term outcomes seem to be similar to the ones achieved in open surgery.

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“…A comparison with open surgery [13] showed less operative time and blood loss with a rise in number of resected nodes. A meta-analysis [14] including 6 studies showed an increased rate of R0 resections.…”

mentioning

confidence: 99%

Robotics in General Surgery: Update and Future Perspectives

Bravo¹,

Mc²,

Js³

et al. 2015

Adv Robot Autom

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Medicine is going through a technological revolution that produces a paradigm shift and makes us think in new ways of treating and diagnosing our patients [1]. Minimally invasive surgery development and routine application in multiple procedures has been the main evolution in the last 50 years, bringing great benefits to patients, surgeons, hospitals and even insurance companies.In laparoscopic surgery the surgeon keeps control by handling patient's tissues inside an insufflated cavity with an external fulcrum point for instrumentation. It changes drastically in robotic surgery, with the surgeon taking place in a virtual environment outside the operative field, with a distant and indirect control. SAGES defines robotic surgery as a surgical procedure that adds a computer technology enhancement interface to the interaction between the surgeon and his patient during a surgical operation and assumes some degree of control heretofore completely reserved for the surgeon.Surgical robots have been envisioned to overcome the limitations and extend the capabilities of human surgeons, allowing them to perform precise and reproducible tasks [2]. Its performance is rooted in the strengths and weaknesses of laparoscopic surgery, being able to avoid the fulcrum effect, overcome the limited range of movements and depth perception, and dismiss the surgeon physiological tremor, while keeping its minimally invasive nature [3].Robotic surgery or computer-assisted surgery is an interactive system fast and intuitive that allows the computer to disappear from the surgeon's mind, who senses as real the environment generated by the system. Through virtual reality, the surgeon defines the manoeuvres that the robot performs in the patient. The consolemanipulator device can be placed in the same operating room, or in a different place, or eventually in another city or country [4,5].Robotic or remote tele-presence surgery is based in two fundamental concepts: virtual reality and cybernetics. Virtual reality achieves 3D immersion effects, navigation, interaction and simulation in real time, making real what the surgeon sees and touches. Cybernetics makes possible the movement digitalisation, promoting the development of mechanical articulated parts programmed with motion degrees, cameras, sensors, information saving and data processing.So far tele-presence surgery uses slave robots that are not programmed to do any movement without surgeon's command, and therefore are completely dependent on his judgement, knowledge and skills. It has a structure that resembles the anatomy of human arms and articulations, capable of imitating movements such as those from shoulders, elbows, wrists and fingers, but exceeding its natural range of motion and increasing the degree of freedom. Da Vinci System® by Intuitive Surgical Inc, the most commonly used device, consists of a surgeon's console, a slave robot with four interactive arms, instruments, a graphic interface and a camera. This design allows the surgeon to operate from a seated position with ergonom...

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Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution

Cited by 182 publications

References 47 publications

PADULAP study: To compare postoperative and pathologic results between open and laparoscopic approach for pancreaticoduodenectomy

PADULAP study: To compare postoperative and pathologic results between open and laparoscopic approach for pancreaticoduodenectomy

Robotic‐assisted pancreatic surgery

Robotics in General Surgery: Update and Future Perspectives

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