Abstract
Even in most complex surgical settings, recent advances in minimal-invasive technologies have made the application of robotic-assisted devices more viable. Due to ever increasing experience and expertise, many large international centers now offer robotic-assisted pancreatic surgery as a preferred alternative. In general however, pancreatic operations are still associated with high morbidity and mortality, while robotic-assisted techniques still require significant learning curves. As a prospective post-marketing trial, we have established optimized operating procedures at our clinic. This manuscript intends to publicize our standardized methodology, including pre-operative preparation, surgical set-up as well as the surgeons’ step-by-step actions when using pancreatic-assisted robotic surgery. This manuscript is based on our institutional experience as a high-volume pancreas operating center. We introduce novel concepts that should standardize, facilitate and economize the surgical steps in all types of robotic-assisted pancreatic surgery. The “One Fits All” principle enables single port placement irrespective of the pancreatic procedure, while the “Reversed 6-to-6 Approach” offers an optimized manual for pancreatic surgeons using the robotic console. Novel and standardized surgical concepts could guide new centers to establish a robust, efficient and safe robotic-assisted pancreatic surgery program.
Highlights
Even in most challenging surgical interventions of the retroperitoneum, minimally invasive techniques are increasingly evaluated for their feasibility and efficacy
From our high-volume center-specific experiences, we present the following Optimized Operating Procedures, for the setting of robotic-assisted pancreatic surgery
Important studies from centers that have already established large programs for robotic-assisted pancreatic surgery have indicated that good performance and major benefits are only achieved after a long learning curve [6, 7]
Summary
Even in most challenging surgical interventions of the retroperitoneum, minimally invasive techniques are increasingly evaluated for their feasibility and efficacy. If there is a good overview, other robotic trocars (R1, R2, R4) are placed in an imaginary horizontal line using standardized distances to avoid robotic arm collisions (see Fig. 2). During this process, any intra-abdominal adhesions are removed using laparoscopic instruments, before introducing the remaining assistant trocars (A1, A2). We believe that this process optimization is important in the robotic setting due to its limited spatial overview when compared to the open situs operations For this reason, our team established a novel concept, named the “Reversed 6-to-6 Approach”: A: Resection
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
