Abstract
AIMTo compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP) and laparoscopic distal pancreatectomy (LDP).METHODSA literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale.RESULTSSeven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.CONCLUSIONRADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required.Core tipTo date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.
Highlights
Laparoscopic surgery represents one of the most important evolutions in surgical treatment in recent years
Compared with Laparoscopic distal pancreatectomy (LDP), robotic-assisted distal pancreatectomy (RADP) was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay
There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups
Summary
Laparoscopic surgery represents one of the most important evolutions in surgical treatment in recent years. Laparoscopic distal pancreatectomy (LDP) is increasingly performed for pancreatic surgery at several specialized surgical institutions worldwide[1,2]. The conventional laparoscopic approach has many advantages such as shorter hospital stay, reduced analgesic requirement, and fewer wound infections[3]. This approach has several disadvantages such as limited range of motion and the fulcrum effect which reverses movements for the surgeon in laparoscopic surgery which is eliminated in robotic surgery just as in open surgery. The number of surgical procedures performed with robotic assistance has increased sharply[6,7]. There are some barriers to the implementation of robotic-assisted distal pancreatectomy (RADP), including the location of the pancreas and the proximity of vascular structures
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