Robotic Pancreatic Surgery, Single Institution’s Experience at a High Volume Minimally Invasive Center

Abstract

Introduction: Minimally invasive pancreas resection has seen rapid development in the past decades, incorporating robotic approach. Robotic pancreatic surgery (RPS) seems to be a safe and feasible option for all types of pancreatic surgery. The purpose of this study is to summarize our experience in this field at a high volume minimally invasive center. Methods: All patients undergoing RPS at Germans Trias Hospital, between April 2018 and December 2020 were analyzed from a prospective database. Clinicopathologic features, perioperative and oncologic outcomes were assessed. Results are expressed as percentage and mean (interquartile range). Results: During the study period a total of 64 minimally invasive surgeries were performed, of which 32 were RPS. 6 Pancreatoduodenectomies, 18 Robotic distal pancreatectomies (4 spleen-preservation), 6 parenchyma-sparing and 2 central pancreatectomies. Sex ratio was, 12 males to 20 females, mean age was 66,4 years (38-78). American Society of Anesthesiologists (ASA) score was 43,7% ASA 2, 40,2% ASA 3 and 16,1% ASA 4, body mass index of 27,7 Kg/m2 (21-35,8), pancreatic fistula rate of 18,7% (12,5 biochemical leak and 6,2% grade A), intraoperative blood loss 183,3 cc (150-450). Conversion was mandatory in 6 cases (18,7%), hospital length-stay was 6,7 days (5-21), Dindo-Clavien ≥3 21,8%. Readmission and reintervention rates were 12,5 and 9,3%, respectively. Oncologic outcomes in malignant cases were as follows; mean lesion size 26,7 mm (12-42mm), R0 resection 87,5%, mean lymph node yield 13,6 (6-26). Conclusion: In our experience, robotic pancreatic surgery is safe and feasible in well-selected patients. Surgical planning and stepwise implementation based on previous experience could help to face this technical demanding procedures, providing the benefits of robotic surgery.