Distal Pancreatectomy Using Clockwise Technique: Laparoscopic vs Robotic Approach

Abstract

Purpose: The 2020 Miami Guidelines for Minimally Invasive Pancreas Resection postulate that both laparoscopic and robotic distal pancreatectomy are safe approeaches. Studies carried out so far suggest comparable results in terms of general morbidity, postsurgical complications, and oncological outcomes. Method: In this video we intend to compare the laparoscopic versus robotic approach of distal pancreatectomy, performed in two similar clinical cases using the “clockwise” technique described in 2002 by HJ Asbun. We are able to visualize the feasibility of this technique in both approaches and the differences found in its five standardized steps. Results: Twenty-four procedures were performed in our centre according to the clockwise technique, ten robotic and fourteen laparoscopic. Two of them needed conversion to open surgery, one from each approach. Median operative time was 194 min (lap: 167 min; robotic: 233 min) and median hospital stay was of 6.6 days. Major morbidity and pancreatic fistula rates were 4% (Clavien Dindo> III) and 20% (including from grade A to C) respectively. Margins were negative in all 24 patients. Conclusion: Robotic left pancreatectomy can offer greater comfort in terms of surgeon ergonomy, better vision, and precision. Larger randomized studies are required to assess the possible differences between these two approaches, paying special attention to the rate of intraoperative complications, splenic preservation rate, oncological results, and cost analysis.