Robot-Assisted Pancreatic Surgery—the Russian Experience.

Abstract

Surgical procedures that involve working in small anatomical spaces can be successfully performed using robot-assisted surgery. We did a retrospective study of the results of 86 robot-assisted pancreatic operations performed in the Abdominal Department No.1 of the A.V. Vishnevsky Institute of Surgery, Moscow. Seventy (81.4%) patients were female, and 16 (18.6%) were male; the average age was 49 (37; 59). The following robot-assisted surgeries were performed: 17 pancreaticoduodenectomies, 45 distal pancreatectomies, 16 tumor enucleations, 6 median resections, and 2 total duodenopancreatectomies. The duration of robot-assisted surgical operations varied depending on the extent of the surgery: for a pancreaticoduodenectomy (PD), it was 400 (360–550) min; for a distal pancreatectomy, it was 210 (180–250) min. Estimated blood loss in a PD was 200 (150–500) ml; in a distal pancreatectomy, it was 100 (50–300) ml. Conversions happened in 6 cases: 2 of them in PD and 4 in distal pancreatectomies. The postoperative length of stay was 15 ± 9 days and depended on the extent of the surgery. The maximum length (16 days) was after robot-assisted pancreaticoduodenectomies (14–25), the minimum (12 days) after organ-preservation surgery (8; 15). Pancreatic fistula А and В occurred in 35 (40.7%) patients and hemorrhages in 6 (7.0%) cases; there were 2 cases of 30-day mortality (2.3%). Robotic assistance can be successfully used in pancreatic surgery. Robot-assisted procedures ensure the precision of lymphadenectomy and anastomoses formation, and the postoperative lengths of stay are more comfortable for patients due to minimal tissue injury. The use of the robot-assisted approach in pancreatic surgery does not guarantee that specific postoperative complications will not occur.