The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center

Liu, Rong; Zhang, Tao; Zhao, Zhiming; Tan, Xiaojie; Zhao, Guodong; Zhang, Xuan; Xu, Yiming

doi:10.1007/s00464-016-5238-6

Cited by 90 publications

(80 citation statements)

References 26 publications

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“…Robotic surgery is thought to be superior to laparoscopy in different disciplines, including urological,[22] gynecological,[23] colorectal,[24] gastric,[25] and distal pancreatic operations,[26] but none have compared RPD to LPD in a large study,[19] as few institutions perform this complex operation using minimally invasive techniques, and the majority have adopted one approach versus the other, preventing single institutional comparison. The robotic platform provides a magnified three-dimensional image, 7 degrees of freedom, and eliminates hand tremor and the fulcrum effect of rigid laparoscopic instruments—allowing for precise suturing, easier tissue handling, better control of large blood vessels, and the ability to work at angles not possible with the laparoscope.…”

Section: Discussionmentioning

confidence: 99%

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Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Nassour

Wang

Porembka

et al. 2017

Journal of Gastrointestinal Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

“…[2–14] The majority of these reports showed that MIPD has at least equivalent postoperative and oncological outcomes compared to OPD but few studies have compared laparoscopic (LPD) versus robotic pancreaticoduodenectomy (RPD) to determine which minimally invasive platform may be best to adopt more broadly. [14–19]…”

Section: Introductionmentioning

confidence: 99%

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Nassour

Wang

Porembka

et al. 2017

Journal of Gastrointestinal Surgery

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“…Robotic surgery presents notable advantagesand revolutionizes minimally invasive surgical approaches. Robotic technology improves many aspects of laparoscopy, including by providing three‐dimensional vision, enhancing dexterity and precision, eliminating surgeons' physiologic tremors, and simulating the wrist …”

Section: Introductionmentioning

confidence: 99%

“…Robotic technology improves many aspects of laparoscopy, including by providing threedimensional vision, enhancing dexterity and precision, eliminating surgeons' physiologic tremors, and simulating the wrist. [12][13][14][15] The last critical step of the radical operation is the Roux-en-Y hepaticojejunostomy. The small, deep and fixed operative field is a limitation for laparoscopy, especially when microsurgical…”

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confidence: 99%

Robotic radical surgery for hilar cholangiocarcinoma: A single‐centre case series

Tan

Zhang

et al. 2020

Robotics Computer Surgery

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Background Radical resection for hilar cholangiocarcinoma is considered one of the most complicated abdominal operations. We report our initial experience with robotic radical resection for hilar cholangiocarcinoma. Methods Between March 2017 and February 2019, the perioperative outcomes of 48 patients were analysed. In addition, there were two techniques for hepaticojejunostomy in the robotic approach. Comparison of the conventional and novel methods for hepaticojejunostomy was also performed to assess the efficacy of the technique. Results The operative duration and intraoperative blood loss volume was 276 minutes and 150 mL, respectively. The overall morbidity was 58.3% and the major morbidity was 10.4%. The overall mortality was 0%. No significant differences in the perioperative outcomes of hepaticojejunostomy were found between the 2 groups. Conclusion Robotic resection is a potential alternative to open surgery for appropriately selected patients with hilar cholangiocarcinoma. Further studies are required to detect the long‐term outcomes of this procedure.

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“…Currently, there is no one standard RPD procedure and for the most part, RPD procedures depend on the surgeon’s experience . Recently, we published our own techniques and demonstrated the learning curve for RPD . RPD procedures differ to open PD surgical techniques, particularly in the reconstruction methods.…”

Section: Introductionmentioning

confidence: 99%

Retrocolic versus antecolic gastrointestinal reconstruction in robotic pancreaticoduodenectomy

Wang

Huang

Zhang

et al. 2019

J Hepato Biliary Pancreat

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Background With the advancement of robotic pancreaticoduodenectomy (RPD), several reconstruction methods have been advocated to make RPD more effective and safer. In this study, we investigated the safety and effectiveness of RPD using a left retrocolic (Lport) technique and compared it with those of RPD using an antecolic technique. Methods Between October 2015 and August 2016, we retrospectively reviewed consecutive cases of RPD before and after introducing the L-port technique for gastrointestinal reconstruction. The L-port technique was mainly performed for retrocolic gastrojejunal reconstruction and some cases of duodenojejunal reconstruction. The perioperative and postoperative outcomes were compared in the two groups. Results Eighty-three cases of RPD were retrieved for statistical analysis. Compared with the antecolic group, the L-port group was significantly associated with a shorter operative time (median time min vs. 390 [370-455] min, P < 0.001), reconstruction time (54 [48-59] min vs. 84 [75-98] min, P < 0.001) and lower incidence of delayed gastric emptying. There were no cases of re-operation due to internal herniation, colonic ischemia, or bowel volvulus in the L-port group during the 1-year follow-up period.Conclusions Our results demonstrated that the L-port technique of RPD is a safe and feasible technique for gastrointestinal reconstruction.

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The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center

Abstract: RPD is more efficient and secure process than LPD among properly selected patients. RPD is therefore a feasible alternative to the laparoscopic procedure. Further studies are needed to evaluate the cost effectiveness of the robotic approach for PD.

Cited by 90 publications

References 26 publications

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis

Robotic radical surgery for hilar cholangiocarcinoma: A single‐centre case series

Retrocolic versus antecolic gastrointestinal reconstruction in robotic pancreaticoduodenectomy

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