Roboscopic minimally invasive pancreaticoduodenectomy: mixing laparoscopic and robotic approach in order to achieve better postoperative outcomes

Abstract

Purpose: Despite the notable expansion of both laparoscopic and robotic pancreatoduodenectomy (PD) the optimal surgical approach is yet to be defined. Whilst laparoscopy offers more agility in moving between different quadrants during the resection phase, the robotic approach offers a more precise and easier suturing during the reconstructive phase. Additionally, most of the robotic protocols report a strong dependence on the laparoscopic assistance and tools during the resection phase. It is likely that both technologies will continue to develop to permit a synergetic combined use of each approach. Herein, we show our technique combining both approaches. Method: We herein provide a video demonstration of our proposed Roboscopic approach, consisting in a pure laparoscopic resection and a full robotic reconstruction. In addition, we report our initial experience with the first 14 consecutive cases. The video shows a Roboscopic PD in a 79-years old woman diagnosed with a 33 mm pancreatic head tumor. Results: The operation time was 340 min(laparoscopic and robotic phase: 180 and160 min, respectively), blood loss was 100 ml. The patient was discharged after 5 days, the postoperative period was uneventful. Among 14 Roboscopic-PD patients, median operation time, blood loss, and fistula risk score were 456 minutes (range:310-628), 190 ml (100-400), and 3 (0-6), respectively. Major complication, POPF (grade B/C) and mortality rates were 36%, 14% and nil, respectively. Postoperative median length of stay was 7 days (IQR 4-29). Conclusion: Roboscopic-PD is safe and feasible and combines the benefits of both the laparoscopic and robotic approach.