Worldwide survey on opinions and use of minimally invasive pancreatic resection

Hilst, Jony van; Rooij, Thijs de; Hilal, Mohammed Abu; Asbun, Horacio J.; Barkun, Jeffrey; Boggi, U.; Busch, Olivier R.; Conlon, Kevin C.; Dijkgraaf, Marcel G. W.; Han, Ho Seong; Hansen, Paul; Kendrick, Michael L.; Montagnini, André L.; Palanivelu, Chinnusamy; Røsok, Bård I.; Shrikhande, Shailesh V.; Wakabayashi, Go; Zeh, Herbert J.; Vollmer, Charles M.; Kooby, David A.; Besselink, Marc G.

doi:10.1016/j.hpb.2017.01.011

Cited by 110 publications

(49 citation statements)

References 20 publications

(20 reference statements)

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“…For robot-assisted pancreatoduodenectomies, surgeons will have completed the LAELAPS-3 training program, consisting of the da Vinci® training course, video training, bio tissue training, and proctoring on-site according to the Pittsburgh approach. Surgeons are considered to have passed the learning curve for safety parameters associated with MIPD after performing 20 MIPDs (excluding procedures with open reconstruction), as confirmed by a recent worldwide survey [ 5 ]. To obtain a high quality of surgical care in the LEOPARD-2 trial, the protocol committee developed six quality criteria that must be met to allow participation in the trial.…”

Section: Methodsmentioning

confidence: 99%

“…Compared with open pancreatoduodenectomy, mortality might be doubled after MIPD in low-volume centers performing fewer than 10 MIPD procedures annually (8% versus 3%; P < 0.01) [ 4 ]. These studies raise concerns about the feasibility and generalizability of MIPD and clearly demonstrate the need for a randomized controlled trial, especially in this era when minimally invasive pancreatic surgery is gaining popularity worldwide [ 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Rooij

Hilst

Bosscha

et al. 2018

Trials

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152

158

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BackgroundData from observational studies suggest that minimally invasive pancreatoduodenectomy (MIPD) is superior to open pancreatoduodenectomy regarding intraoperative blood loss, postoperative morbidity, and length of hospital stay, without increasing total costs. However, several case-matched studies failed to demonstrate superiority of MIPD, and large registry studies from the USA even suggested increased mortality for MIPDs performed in low-volume (<10 MIPDs annually) centers. Randomized controlled multicenter trials are lacking but clearly required. We hypothesize that time to functional recovery is shorter after MIPD compared with open pancreatoduodenectomy, even in an enhanced recovery setting.Methods/designLEOPARD-2 is a randomized controlled, parallel-group, patient-blinded, multicenter, phase 2/3, superiority trial in centers that completed the Dutch Pancreatic Cancer Group LAELAPS-2 training program for laparoscopic pancreatoduodenectomy or LAELAPS-3 training program for robot-assisted pancreatoduodenectomy and have performed ≥ 20 MIPDs. A total of 136 patients with symptomatic benign, premalignant, or malignant disease will be randomly assigned to undergo minimally invasive or open pancreatoduodenectomy in an enhanced recovery setting. After the first 40 patients (phase 2), the data safety monitoring board will assess safety outcomes (not blinded for treatment allocation) and decide on continuation to phase 3. Patients from phase 2 will then be included in phase 3. The primary outcome measure is time (days) to functional recovery. All patients will be blinded for the surgical approach, at least until postoperative day 5, but preferably until functional recovery has been attained. Secondary outcome measures are operative and postoperative outcomes, including clinically relevant complications, mortality, quality of life, and costs.DiscussionThe LEOPARD-2 trial is designed to assess whether MIPD reduces time to functional recovery, as compared with open pancreatoduodenectomy in an enhanced recovery setting.Trial registrationNetherlands Trial Register, NTR5689. Registered on 2 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2423-4) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Rooij

Hilst

Bosscha

et al. 2018

Trials

Self Cite

152

158

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“…They conclude that laparoscopic PD should be limited to patients with a low risk of pancreatic fistula formation. A survey was sent to the members of six international hepatobiliary surgical societies [18]. A total of 435 surgeons from 50 countries responded.…”

Section: Laparoscopic Surgery For Malignant Lesions Of the Pancreasmentioning

confidence: 99%

Robotic and laparoscopic surgery of the pancreas: an historical review

Lefor

2019

BMC biomed eng

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Surgery of the pancreas is a relatively new field, with operative series appearing only in the last 50 years. Surgery of the pancreas is technically challenging. The entire field of general surgery changed radically in 1987 with the introduction of the laparoscopic cholecystectomy. Minimally Invasive surgical techniques rapidly became utilized worldwide for gallbladder surgery and were then adapted to other abdominal operations. These techniques are used regularly for surgery of the pancreas including distal pancreatectomy and pancreatoduodenectomy. The progression from open surgery to laparoscopy to robotic surgery has occurred for many operations including adrenalectomy, thyroidectomy, colon resection, prostatectomy, gastrectomy and others. Data to show a benefit to the patient are scarce for robotic surgery, although both laparoscopic and robotic surgery of the pancreas have been shown not to be inferior with regard to major operative and oncologic outcomes. While there were serious concerns when laparoscopy was first used in patients with malignancies, robotic surgery has been used in many benign and malignant conditions with no obvious deterioration of outcomes. Robotic surgery for malignancies of the pancreas is well accepted and expanding to more centers. The importance of centers of excellence, surgeon experience supported by a codified mastery-based training program and international registries is widely accepted. Robotic pancreatic surgery is associated with slightly decreased blood loss and decreased length of stay compared to open surgery. Major oncologic outcomes appear to have been preserved, with some studies showing higher rates of R0 resection and tumor-free margins. Patients with lesions of the pancreas should find a surgeon they trust and do not need to be concerned with the operative approach used for their resection. The step-wise approach that has characterized the growth in robotic surgery of the pancreas, in contradistinction to the frenzy that accompanied the introduction of laparoscopic cholecystectomy, has allowed the identification of areas for improvement, many of which lie at the junction of engineering and medical practice. Refinements in robotic surgery depend on a partnership between engineers and clinicians.

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“…The recent worldwide survey among pancreatic surgeons performing MIDP demonstrated that only 12% of surgeons found no contraindications for MIDP [27]. In a similar pan-European survey, 45% of surgeons claimed that they had insufficient training in MIDP for all indications [28].…”

Section: Minimally Invasive Distal Pancreatectomymentioning

confidence: 99%

“…Interestingly, 65% of responders view laparoscopy in pancreatoduodenectomy as a technical problem. The most frequently mentioned technical concern during MIPD is construction of pancreatic anastomosis [27].…”

Section: Minimally Invasive Pancreatoduodenectomymentioning

confidence: 99%

Minimally invasive pancreatic surgery—where are we going?

et al. 2019

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Background Introduced in the mid-1990s, minimally invasive pancreatic surgery (MIPS) developed slowly over the next two decades, and its real-life benefits remained unclear. Methods In this review, the current status and evidence on the most common types of MIPS, such as minimally invasive pancreatoduodenectomy (MIPD), distal pancreatectomy, enucleation, and central pancreatectomy are presented. Results Minimally invasive distal pancreatectomy (MIDP) is the most frequently used procedure among

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Worldwide survey on opinions and use of minimally invasive pancreatic resection

Cited by 110 publications

References 20 publications

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Robotic and laparoscopic surgery of the pancreas: an historical review

Minimally invasive pancreatic surgery—where are we going?

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