Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study

Alfieri, Sergio; Butturini, Giovanni; Boggi, Ugo; Pietrabissa, Andrea; Morelli, Luca; Vistoli, Fabio; Damoli, Isacco; Peri, Andrea; Fiorillo, Claudio; Pugliese, Luigi; Ramera, Marco; Lio, Nelide De; Franco, Gregorio Di; Esposito, Alessandro; Landoni, Luca; Rosa, Fausto; Menghi, Roberta; Doglietto, Giovanni Battista; Quero, Giuseppe

doi:10.1007/s00423-019-01786-x

Cited by 43 publications

(42 citation statements)

References 45 publications

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“…Also, the enhancements made in the Xi of simpler docking, laser guided port placement and boom-mounted robotic arms could have played a role in the faster times of draping and docking we found. Comparison to other studies is hard and unreliable due to unclearly described definitions of reported time frames [3,[12][13][14][15][16], different way of docking (three arms or single-port) [6,17,18], method of data collection and/or to retrospective study designs [3,[17][18][19]. Robot-assisted surgery, especially the phase before the surgeon starts behind the console, is a team effort.…”

Section: Discussionmentioning

confidence: 99%

From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot

et al. 2020

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Robot-assisted surgery is assumed to be time consuming partially due to extra time needed in preparing the robot. The objective of this study was to give realistic times in Da Vinci Xi draping and docking and to analyse the learning curve in the transition from the Si to the Xi in an experienced team. This prospective study was held in a hospital with a high volume of robot-assisted surgery in general surgery, urology and gynaecology. Times from the moment patients entered the operating room until the surgeon took place behind console were precisely recorded during the first 6 weeks after the implementation of the Xi. In total, 65 procedures were performed and documented. The learning curve for the process of draping and docking the robot was reached after 21 and 18 cases, respectively. Mean times after completion of the learning curve were 5 min for draping and 7 min for docking and were statistically different from mean times before completion of the learning curve (p values < 0.01). In dedicated teams netto extra time needed for preparing the Xi can even be reduced to just the time needed for docking. Thus, setting up the robot should have limited impact on overall time spent in the operation room.

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Section: Discussionmentioning

confidence: 99%

From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot

et al. 2020

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“…RDP was shown to be safe and feasible with advantages in terms of intraoperative blood loss, conversion rate, and spleen preservation rate. [9][10][11][12][13][14][15] However, limitations of these studies include small sample sizes, the retrospective study design, and the long time span, sometimes making the results questionable.…”

Section: Introductionmentioning

confidence: 99%

Full Robotic Distal Pancreatectomy: Safety and Feasibility Analysis of a Multicenter Cohort of 236 Patients

Alfieri

Boggi

Butturini³

et al. 2019

Surg Innov

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Introduction. Despite the widespread use of the robotic technology, only a few studies with small sample sizes report its application to pancreatic diseases treatment. Our aim is to present the results of a multicenter study on the safety and feasibility of robot-assisted distal pancreatectomy (RDP). Materials and Methods. All RDPs for benign, borderline, and malignant diseases performed in 5 referral centers from 2008 to 2016 were included. Perioperative outcomes were evaluated. Results. Two hundred thirty-six patients were included. Spleen preservation was performed in 114 cases (48.3%). Operative time was 277.8 ± 93.6 minutes. Progressive improvement in operative time was observed over the study period. Conversion rate was 6.3%. Morbidity occurred in 102 cases (43.2%), mainly due to grade A fistulas. Reoperation was required in 10 patients. Postoperatively, 2 patients died of sepsis due to a grade C fistula. Hospital readmission was necessary in 11 cases. A R0 resection was always achieved, with a mean number of 16.2 ± 15 harvested lymph nodes. Conclusion. To our knowledge, this is one of the largest RDP series. Safety and feasibility including the low conversion rate, the high spleen preservation rate, the adequate operative time, and the acceptable morbidity and mortality rates confirm the validity of this technique. Appropriate oncological outcomes have been also obtained.

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“…Laparoscopic distal pancreatectomies have similar oncological outcomes and levels of post-operative complications as open distal pancreatectomies but shorter hospital stays[ 6 , 7 , 17 ]. The other study also showed that robotic assisted distal pancreatectomy and laparoscopic distal pancreatectomy were similar in post-operative complication and long term outcomes[ 18 ]. Some studies have also been conducted in functional-PNET and NF-PNET patients.…”

Section: Discussionmentioning

confidence: 98%

Minimally invasive vs open pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors

Kim¹,

Hwang²,

Lee³

et al. 2020

WJGO

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BACKGROUND The mainstay of treating nonfunctioning-pancreatic neuroendocrine tumors(NF-PNETs) is surgical resection. However, minimally invasive approaches to pancreatic resection for treating NF-PNETs are not widely accepted, and the long-term oncological outcomes of such approaches remain unknown. AIM To determine the short- and long-term outcomes of minimally invasive pancreatic resection conducted in patients with NF-PNETs. METHODS Prospective databases from Severance Hospital were searched for 110 patients who underwent curative resection for NF-PNETs between January 2003 and August 2018. RESULTS The proportion of minimally invasive surgery (MIS) procedures performed for NF-PNET increased to more than 75% after 2013. There was no significant difference in post-operative complications ( P = 0.654), including pancreatic fistula ( P = 0.890) and delayed gastric emptying ( P = 0.652), between MIS and open approaches. No statistically significant difference was found in disease-free survival between the open approach group and the MIS group (median follow-up period, 28.1 mo; P = 0.428). In addition, the surgical approach (MIS vs open) was not found to be an independent prognostic factor in treating NF-PNET patients [Exp(β) = 1.062; P = 0.929]. CONCLUSION Regardless of the type of surgery, a minimally invasive approach can be safe and feasible for select NF-PNET patients.

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Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study

Cited by 43 publications

References 45 publications

From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot

From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot

Full Robotic Distal Pancreatectomy: Safety and Feasibility Analysis of a Multicenter Cohort of 236 Patients

Minimally invasive vs open pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors

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