Approach For Distal Pancreatectomy Research Articles

Robotic Dual-Console Distal Pancreatectomy: Could it be Considered a Safe Approach and Surgical Teaching even in Pancreatic Surgery? A Retrospective Observational Study Cohort

BackgroundThe study aims to assess the safety and feasibility of the robotic dual-console during a robotic distal pancreatectomyMethodsThe data of the consecutive patients submitted to RDP from 2012 to 2019 at the Verona University were retrieved from a prospectively maintained database. The patients submitted to RDP were divided into the dual-console platform group (DG) and compared to the standard robotic procedure group (SG).ResultsIn the study period, 102 robotic distal pancreatectomies were performed, of whom 42 patients (41%) belonged to the DG and 60 patients (59%) to the SG. Higher operation time was recorded in the DG compared to the SG (410 vs. 265 min, p < 0.001). The overall conversion rate of the series was 7% (n 7 patients). All the conversions were observed in the SG (p = 0.021). No differences in morbidity or pancreatic fistula rate were recorded (p > 0.05). No mortality events in the 90th postoperative days were reported in this series.ConclusionsThe robotic dual-console approach for distal pancreatectomy is safe, feasible, and reproducible. The postoperative surgical outcomes are comparable to the standard RDP with the single-console da Vinci Surgical System®. This surgical technique can widely and safely improve the robotic surgical training program.

A multicenter survey on distal pancreatectomy in Italy: results of minimally invasive techniqueand variability of perioperative pathways.

No data are available about distal pancreatectomy (DP) in Italy, regarding variability of care among centers, and outcome of minimally invasive distal pancreatectomy (MIDP) in a multicenter setting. Hence, a survey was conducted among 20 institutions experienced in pancreatic surgery by the Italian Association for Study of Pancreas. Centers were asked to fill in two questionnaires about (1) general approach and perioperative protocols for DP and MIDP; (2) detailed operative results of MIDP in the period 2010-2011. Results of questionnaire 1: a great variability in perioperative approach was observed: octreotide was used in 50 % of centers, enzyme supplementation in 35 %, postoperative gastric suction in 80 % and oral liquids on day 1 in 55 %. All hospitals used at least one drain and its removal ranged between days 3-5 (in absence of fistula). Differences in type and timing of post-splenectomy vaccinations were recorded. As regards MIDP, 17/20 centers performed laparoscopic or robotic DP. MIDP rate on overall DP varied among centers (range 0-82 %) and it doubled from 2007 (14 %) to 2011 (28 %). Results of questionnaire 2: in the period 2010-2011, 171 MIDP were performed (140 laparoscopic, 31 robotic). Overall conversion rate was 17 %, mean operative time was 230 min and blood loss 285 ml. Mortality was nil and morbidity was 62 %, with 4 % relaparotomies. Pancreatic fistula occurred in 49 % (grade A 35 %, B 14 %). Mean postoperative stay was 9.8 days with 10 % readmission rate. The results indicated a great variability in DP management among Italian centers. Most centers performed MIDP, but MIDP rate on overall DP largely varied among centers. As regards MIDP conversion rate and hospital stay were found to be worse than those in single-institution series.

Endoscopic Total Retroperitoneal Distal Pancreatectomy in a Large Animal Model

Traditionally, distal pancreatic lesions are resected by the open technique. An ever-increasing number of laparoscopic transperitoneal distal pancreatectomy cases are being reported. This study explores the possibility of performing distal pancreatectomy via an endoscopie retroperitoneal approach. This study was done in two stages using a total of 15 pigs: the first stage involved dissection in euthanized pigs, and the second stage involved anesthetized pigs. In both stages of the study, distal pancreatectomy could be performed within an acceptable time frame and with acceptable resection margins and morbidity rate. We introduce the concept of endoscopie total retroperitoneal distal pancreatectomy as an approach for distal pancreatectomy.

ENDOSCOPIC TOTAL RETROPERITONEAL DISTAL PANCREATECTOMY IN A LARGE ANIMAL MODEL

Traditionally, distal pancreatic lesions are resected by the open technique. An ever-increasing number of laparoscopic transperitoneal distal pancreatectomy cases are being reported. This study explores the possibility of performing distal pancreatectomy via an endoscopic retroperitoneal approach. This study was done in two stages using a total of 15 pigs: the first stage involved dissection in euthanized pigs, and the second stage involved anesthetized pigs. In both stages of the study, distal pancreatectomy could be performed within an acceptable time frame and with acceptable resection margins and morbidity rate. We introduce the concept of endoscopic total retroperitoneal distal pancreatectomy as an approach for distal pancreatectomy.

Laparoscopic distal pancreatectomy in the pig using ultrasonic dissector device

SummaryObjective: To analyse in a porcine model the outcome of laparoscopic distal pancreatectomy using an ultrasonic dissection device. Design and subjects: Six week survival study in Suabian Hall landrace pigs. Interventions: Laparoscopic distal pancreatectomy using an ultrasonic dissection device. Main outcome measures: Analysis of inflammatory response, healing complications and tissue injury. Results: In four of five animals the left pancreatic segment was resected via the laparoscopic approach, preserving the spleen and splenic vessels. In one animal the operative procedure had to be converted to open access surgery due to bleeding from the splenic vein with resection of the spleen and distal pancreatectomy using the ultrasonic dissector. All animals survived the 6-week observation period without signs of fistula or infection. There was no increase of WBC count and serum p-amylase during post-operative follow up, indicating absence of systemic inflammatory response and local tissue injury. Histomorphologic analysis of the pancreatic stump 6 weeks after ultrasonic resection confirmed intact pancreatic acinar tissue without signs of inflammation or fibrosis/necrosis. Conclusion: We propose that laparoscopic resection of the left pancreatic segment with the ultrasonic dissector represents a promising new approach for distal pancreatectomy.