Surgical resection of pancreatic neuroendocrine neoplasm by minimally invasive surgery—the robotic approach?

Abstract

Over the past decade, there has been increasing adoption of minimally invasive pancreatic surgery world-wide and this has naturally expanded to the management of pancreatic neuroendocrine neoplasms (PNENs). More recently, robotic pancreatic surgery (RPS) was introduced to overcome the limitations during laparoscopic pancreatic surgery (LPS). Due to the relative rarity of PNEN and the novelty of minimally invasive pancreatic surgery in particular RPS today, the evidence for robotic surgery in PNENs remains extremely limited. Presently, the available evidence is limited to a few low level retrospective case-control studies. These studies suggest that RPS may be associated with a higher splenic preservation rates and lower open conversion rates compared to conventional laparoscopic surgery. Ideally a prospective randomized trial should be performed but this would be extremely challenging due to the rarity of PNEN, making it almost impossible to conduct a sufficiently powered trial.

A single institution experience with robotic and laparoscopic distal pancreatectomies

“…version rate to open surgery compared to LDP. 2,10,14,24,25 In this study, subtotal pancreatectomy was performed significantly more frequently for tumors located in the neck or body via the robotic approach. Some surgeons may propose central pancreatectomy as a parenchymasaving approach for these tumors especially when these tumors are not suggestive of invasive cancer.…”

“…However, it is important to note that the costs of robotic systems will likely decrease in the near future with increasing availability and competition in the market. 18,24,39 Many investigators have demonstrated the safety and feasibility of RDP in comparison with LDP as the incidence of total postoperative complications were similar between the two. 1,2 Similarly, the results of our study showed no significant difference between RDP and LDP in terms of the frequency of total complications, major morbidity, pancreatic fistula, and readmission rate.…”

“…Nonetheless, it is important to highlight that selection bias whereby surgeons may have preferred the robotic platform for patients planned for splenic preservation, may have also accounted for the higher spleen-preservation rate. 24 Other confounding factors such as location of tumor (proximity to splenic hilum) may also affect the surgeon's decision to attempt splenic preservation.…”

“…As the cost of purchasing and maintain the robot is also significant, relatively few surgeons globally have regular access to the robotic technology for training, contributing to the lack of familiarity and experience with the system. 18,24 Hence, the barrier to introduce robotic surgery to many institutions worldwide is relatively high. However, it is important to note that the costs of robotic systems will likely decrease in the near future with increasing availability and competition in the market.…”

Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia

“…[ 1 2 ] In recent years, improved knowledge and standardisation of MIPS techniques in addition to rapid advancements in the development of minimally invasive surgical device technology such as the introduction of improved high-definition laparoscopes and new advanced energy devices have allowed more surgeons throughout the world to perform MIPS. [ 2 4 5 ] Hence, the indications of MIPS have expanded as surgeons gained increasing experience with MIPS,[ 1 2 6 ] from less complicated distal pancreatectomies (DP)[ 7 8 ] and enucleations[ 9 ] to more complicated procedures such as central pancreatectomies[ 10 ] and pancreatoduodenectomies (PD)[ 11 12 ] including even extended pancreatic resections requiring vascular resections. [ 13 ]…”