Abstract
Introduction: The objective was to use video analysis of robot-assisted pancreatico-jejunostomy (PJ) to identify technical intraoperative risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF). Methods: Retrospective analysis of the LAELAPS-3 study. All consecutive patients who underwent a robot-assisted PD from 2017 – June 2020 were included. Technical intraoperative factors of the PJ were collected by a blinded assessor through analysis of the recorded videos. The main outcome was CR-POPF, defined as grade B/C fistula. All PJ’s were performed using the modified Blumgart technique. Results: The videos of 153 robotic assisted PJ’s were analyzed. The CR-POPF rate was 22.9% (n=35). Based on uaFRS criteria, 72 (47.1%) patients had intermediate or high-risk anastomoses. In 14 patients (9.2%) a defect of >1mm between stitches of the duct to mucosa was observed. Patients with a defect of >1mm had an increased risk to develop a CR-POPF; adjusted odds ratio (OR) 4.07 (95%CI 1.18 – 14.04, p=0.026). In four patients (2.6%) more than half of the stitches from the duct-to-mucosa did not pass through the mucosa of the jejunum. These patients had an increased risk to develop a grade C fistula (OR 29.7, 95%CI 1.409 - 596, p=0.027). Conclusions: Using video analysis of robot-assisted PJ, we found that a defect of >1mm and a duct-to-mucosa stitch not incorporating the mucosa are associated with CR-POPF. Video analysis can be used to improve outcomes especially in the learning curve. FP02-5.
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