Robot-assisted Distal Pancreatectomy Research Articles

Robot-assisted distal pancreatectomy with spleen preservation in the treatment of a child with a solid pseudopapillary tumor

The use of robots in pancreatic surgery offers several advantages as an adjunct to laparoscopic surgery, including increased maneuverability of robotic instruments and three-dimensional (3D) visualization. To our knowledge, only two cases of robot-assisted distal pancreatectomy with spleen preservation in children have been reported worldwide. In this study, the patient was an 11-year-old boy who was admitted to a children’s hospital with complaints of recurrent upper abdominal pain. He was diagnosed with pancreatic tumor based on ultrasound findings. It was confirmed by magnetic resonance imaging, which revealed a well-defined heterogeneous formation at the border of the body and tail of the pancreas, measuring 2.28 × 2.73 × 2.62 cm with compression of the Wirsung duct. The surgical intervention was performed using a surgical robot VERSIUS (CMR, (UK). Splenic vessels were mobilized carefully, a tourniquet was placed around the body of the pancreas, and it was intersected using a stapler at the border of healthy tissue. The surgical intervention took 340 min, including robot installation time (docking time) of 15 min and a main console time of 325 min. No serious intraoperative complications, such as bleeding or damage to the vascular structures adjacent to the pancreas (branches of the celiac trunk and portal vein), were noted. Histological examination of the tumor confirmed the diagnosis of a solid pseudopapillary tumor. After surgery, the patient’s condition was stable. Recovery proceeded without complications. Magnetic resonance imaging of the abdominal cavity, which was performed 6 months after surgery, revealed no signs of disease recurrence. Robot-assisted surgery is an acceptable alternative to laparoscopic and open surgery for patients with solid pseudopapillary pancreatic tumors because robots offer additional connections, enable closure in improved 3D imaging, increase dexterity when handling instruments, and eliminate of hand tremors.

Short-Term Outcomes of Conventional Laparoscopic versus Robot-Assisted Distal Pancreatectomy for Malignancy: Evidence from US National Inpatient Sample, 2005-2018.

The primary treatment for pancreatic cancer is surgical resection, and laparoscopic resection offers benefits over open surgery. This study aimed to compare the short-term outcomes of robot-assisted vs. conventional laparoscopic distal pancreatectomy. Data of adults ≥ 20 years old with pancreatic cancer who underwent conventional laparoscopic or robot-assisted laparoscopic distal pancreatectomy were extracted from the United States (US) Nationwide Inpatient Sample (NIS) 2005-2018 database. Comorbidities and complications were identified through the International Classification of Diseases (ICD) codes. Short-term outcomes were compared using logistic regression and included length of hospital stay (LOS), perioperative complications, in-hospital mortality, unfavorable discharge, and total hospital costs. A total of 886 patients were included; 27% received robot-assisted, and 73% received conventional laparoscopic surgery. The mean age of all patients was 65.3 years, and 52% were females. Multivariable analysis revealed that robot-assisted surgery was associated with a significantly reduced risk of perioperative complications (adjusted odds ratio (aOR) = 0.61, 95% confidence interval (CI): 0.45-0.83) compared to conventional laparoscopic surgery. Specifically, robot-assisted surgery was associated with a significantly decreased risk of VTE (aOR = 0.35, 95% CI: 0.14-0.83) and postoperative blood transfusion (aOR = 0.37, 95% CI: 0.23-0.61). Robot-assisted surgery was associated with a significantly shorter LOS (0.76 days shorter, 95% CI: -1.43--0.09) but greater total hospital costs (18,284 USD greater, 95% CI: 4369.03-32,200.70) than conventional laparoscopic surgery. Despite the higher costs, robot-assisted distal pancreatectomy is associated with decreased risk of complications and shorter hospital stays than conventional laparoscopic distal pancreatectomy.

Accurate intraoperative real-time blood flow assessment of the remnant stomach during robot-assisted distal pancreatectomy with celiac axis resection using indocyanine green fluorescence imaging and da Vinci Firefly technology.

Ischemic gastropathy is one of the unique postoperative complications associated with distal pancreatectomy with celiac axis resection for locally advanced pancreatic cancer. Therefore, it is essential to evaluate blood flow to the stomach following a resection; however, no intraoperative procedures have been established to assess this issue. Herein we describe two cases in which intraoperative evaluation of real-time blood flow in the residual stomach was performed using indocyanine green fluorescence and da Vinci Firefly technology during a robot-assisted distal pancreatectomy with celiac axis resection. Robot-assisted distal pancreatectomy with celiac axis resection was performed using a da Vinci Xi surgical system on two patients with locally advanced pancreatic cancer and suspected invasion of the celiac artery. Indocyanine green (ICG) (0.5mg/kg) was injected intravenously after resection to evaluate real-time blood flow of the stomach using the da Vinci Firefly system. Blood flow of the stomach was evaluated 60 seconds after the intravenous injection of ICG. All cases were confirmed that there was sufficient blood flow in the residual stomach. Therefore, reconstruction of the left gastric artery was not performed, and the surgery was completed with preservation of the stomach. Good postoperative outcomes were achieved and there was no evidence of ischemic gastropathy or delayed gastric emptying in both cases. This method is very useful in determining whether or not to perform reconstruction of the left gastric artery and/or additional resection of the remnant stomach during a robot-assisted distal pancreatectomy with celiac axis resection.

Comparison of different pancreatic stump management strategies during robot-assisted distal pancreatectomy.

Postoperative pancreatic fistula (POPF) represents the most feared complication after distal pancreatectomy, and the possible role of robotic assistance in this setting is poorly investigated so far. We analysed short-term outcomes of 88 patients who had undergone robot-assisted distal pancreatectomy (RDP), dividing them according to pancreatic stump management: selective Wirsung duct ligation/hand sewn suture (WirsLIG group), use of robotic EndoWrist staplers (RobSTAP group), and use of laparoscopic staplers (LapSTAP group). Mean operative time resulted significantly longer in WirsLIG group (291.1±77.21min vs. 245±56.22min in RobSTAP group vs. 221.77±64.64min in LapSTAP group). No significant differences were found in median hospital stay and in POPF occurrence. No strategy for pancreatic stump management during RDP has proven superior to the others in reducing POPF rates. The hand-sewn technique resulted more time consuming, nevertheless it remains essential where there is not enough space to insert the stapler.

The learning curve for robot-assisted distal pancreatectomy: a single-center experience of 301 cases.

We collected and retrospectively analyzed the single-center surgical experience of 301 patients undergoing RDP at Peking Union Medical College Hospital (PUMCH) between 2012 and 2022 and described the change in operation proficiency and occurrence of perioperative complications in this observational study. The learning curve was assessed using the cumulative sum method. We observed a three-phase pattern of RDP learning with operation time, complications, and postoperative pancreatic fistula as indicators and a two-phase pattern for spleening-preserving success. The mean operation time was 3.9 hours. The incidence rate of clinically significant postoperative pancreatic fistula (CRPOPF) was 17.9% and overall Clavien-Dindo complication rate (≥3) was 16.6%. The change of postoperative complicate rate was correlated with percentage of malignant cases. In the last decade, an evident decrease was seen in operation time, complication rate, and an increase in the spleen-preserving rate of distal pancreatectomy. With proper training, RDP is a safe and feasible procedure.

Impact of the transection plan on postoperative pancreatic fistulas occurring after robot-assisted distal pancreatectomy for nonmalignant pancreatic neoplasms.

Postoperative pancreatic fistula (POPF) is the main complication of distal pancreatectomy (DP) and affects the prognosis of patients. The impact of several clinical factors mentioned in recent studies on POPF remains controversial. This study aimed to investigate the impact of a remnant pancreas and other perioperative factors on POPFs occurring after robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms. A total of 197 patients who received robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms at the Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2018 to December 2020 were included in this retrospective study. According to the intraoperative transection plan, patients were divided into an RDP body group and an RDP tail group. Clinical and pathological features and perioperative factors affecting POPF were analyzed and compared between the two groups. The results showed that a transection plan involving the tail of the pancreas (OR = 2.133, 95% CI 1.109-4.103, p = 0.023) and spleen preservation (OR = 2.588, 95% CI 1.435-4.665, p = 0.001) independently increased the incidence of POPF in patients with nonmalignant pancreatic neoplasms treated by RDP. A transection plan involving the tail of the pancreas was also an independent risk factor (OR = 3.464, 95% CI 1.270-9.450, p = 0.015) for grade B/C POPF. Length of remnant pancreas > 6.23cm was an independent risk factor for POPF (OR = 3.116, 95% CI 1.364-7.121, p = 0.007). Length of remnant pancreas > 9.82cm was an independent risk factor for grade B/C POPF (OR = 3.340, 95% CI 1.386-8.051, p = 0.007). This retrospective study suggests that a transection plan involving the tail of the pancreas is an independent risk factor for POPF in patients with nonmalignant neoplasms treated by RDP. We also propose that the postoperative length of the remnant pancreas evaluated by computed tomography scans can be used to identify patients with a high risk of POPF in order to optimize the individualized strategy.

Comparison between robot-assisted middle pancreatectomy and robot-assisted distal pancreatectomy for benign or low-grade malignant tumours located in the neck of the pancreas: A propensity score matched study.

To compare the short-term and long-term outcomes between robot-assisted middle pancreatectomy (RMP) and robot-assisted distal pancreatectomy (RDP). From August 2010 to May 2018, more than 800 patients were diagnosed with benign or low-grade malignant pancreatic tumours. According to the inclusion criteria, a total of 164 patients were included in our study. Among them 123 patients received RMP and 41 patients received RDP with spleen-preserving. These patients were divided into two groups, and propensity score matching (PSM) was used to minimize bias. Short-term and long-term outcomes were recorded and analysed. After 1:1 matching, 38 cases of RMP and RDP were recorded and the baseline data was balanced. In the RMP group, 14 patients (36.8%) were female. In the RDP group, 13 patients (34.2%) were female. RDP had advantages in short-term outcomes including overall morbidity (28.9% vs. 60.5%, p=0.011), Severe morbidity (0 vs. 10.5%, p=0.017), clinical-relevant postoperative pancreatic fistula (CR-POPF) rate (10.5% vs. 36.8%, p=0.007) and postoperative length of hospital stay (16.5±8.6 days vs. 23.6±12.9 days, p=0.006). The operative time was similar; however, there were less estimated blood loss (EBL) in RMP group (31.3±33.0ml vs. 62.3±38.2ml, p<0.001). Patients in these two groups had a similar result in preservation of the pancreatic function. There was no statistic difference in incidence rate of exocrine and endocrine insufficiency between two groups (2.6% vs. 7.9%, p=0.608; 5.3% vs. 10.5%, p=0.671). For benign or low-grade malignant tumours located at the neck of the pancreas, RMP and RDP could both be considered. The morbidity especially CR-POPF rate after RDP would be lower, but RMP would be more helpful in reducing EBL. RMP should be chosen with caution as it did not show a huge advantage in preserving normal pancreatic function. Further prospective randomised studies should be designed to compare these two types of surgery.

Distal pancreatectomy for giant pancreatic pseudocyst with splenic rupture in a patient with chronic pancreatitis

Pancreatic pseudocysts are a frequent complication of chronic pancreatitis. Spontaneous splenic rupture and subcapsular hematoma is a rare and fatal event in a pseudocyst. In the literature, the real incidence of this kind of complication is not clearly defined. We herein present a case of a 31 year-old male with a large pseudocyst associated with splenic rupture. The patient had a history of acute alcoholic pancreatitis three months ago in another hospital centre. He presented at our emergency department with abdominal pain and poor general condition (hemodynamic instability). After resuscitation, an abdominal CT scan was performed, which showed a giant pseudocyst (16x17x24cm, APxLxCC) causing a splenic rupture contained by the spleen capsule. After multidisciplinary committee, we proposed a minimally invasive surgical approach. Previously, we proposed drainage by percutaneous approach of the pseudocyst. The procedure were performed without incidences. After drainage, we performed a minimally robot-assisted distal pancreatectomy with splenectomy using Da Vinci Xi system. Five trocars were used, the operative time was 321min, we used Echelon black cartridge-mechanical staple for pancreatic transection. A grade B pancreatic fistula occured in the immediate postoperative period, adequately drained and treated with somatostatin analogues. We removed the drain at the outpatient consultation three weeks after surgery. The anatomo-pathology reported a peripancreatic pseudocyst with extensive acute and subacute bleeding and inflammatory changes. Keywords: Angiographic drainage, pseudocyst, spleen rupture, robot-assisted surgery. Figure legend: △: main pancreatic duct (pancreatic tail); →:splenic capsular dissection; ✱: spleen; ✱: pseudocyst

Robot-assisted spleen preserving distal pancreatectomy: case report

: A 28-year-old female patient was incidentally diagnosed with a unilocular pancreatic cystic lesion located in the body-tail of the pancreas. Findings at contrast-enhanced computed tomography scan and magnetic resonance were both consistent with the diagnosis of mucinous cystadenoma. The patient was then scheduled for a robot-assisted distal pancreatectomy with preservation of the spleen and the splenic vessels. The procedure was completed safely in 255 minutes with minimal blood loss. The post-operative course was uneventful and the patient was discharged on post-operative day 6. Final pathology confirmed the diagnosis of mucinous cystadenoma. In the video presented herein we show the technique for robot-assisted distal pancreatectomy with preservation of the spleen and the splenic vessels.

Robot-assisted distal pancreatectomy: a comparison between different strategies for the pancreatic stump management

Robot-assisted distal pancreatectomy: a comparison between different strategies for the pancreatic stump management

Epithelial cyst arising in an intrapancreatic accessory spleen: a case report of robotic surgery and review of minimally invasive treatment

BackgroundAn epithelial cyst in an intrapancreatic accessory spleen (ECIPAS) is rare. We report a case of ECIPAS that was treated with robot-assisted distal pancreatectomy with splenectomy.Case presentationThe case was a 59-year-old woman who was referred to our hospital after a pancreatic tail tumor was found on computed tomography prior to surgery for small bowel obstruction at another hospital. A cystic lesion in the pancreatic tail was discovered and evaluated by magnetic resonance imaging and endoscopic ultrasonography. Based on clinical and radiological features, mucinous cystic neoplasm was included in the differential diagnosis. The patient underwent robot-assisted distal pancreatectomy with splenectomy. The postoperative course was uneventful. Pathological evaluation revealed a 20-mm ECIPAS in the pancreatic tail.ConclusionsIf a pancreatic tail tumor is present, ECIPAS should be included in the differential diagnosis. However, preoperative diagnosis is difficult, and a definitive diagnosis is often not obtained until after surgery. Surgery should be minimally invasive. Laparoscopic distal pancreatectomy has become a standard surgical procedure because it is minimally invasive. Robot-assisted surgery is not only minimally invasive, but also advantageous, because it has a stereoscopic magnifying effect and allows the forceps to move smoothly. Robot-assisted distal pancreatectomy may be a good option, when performing surgery for a pancreatic tail tumor.

Comparison of 3 Minimally Invasive Methods Versus Open Distal Pancreatectomy: A Systematic Review and Network Meta-Analysis.

The efficacy and safety of open distal pancreatectomy (DP), laparoscopic DP, robot-assisted laparoscopic DP, and robotic DP have not been established. The authors aimed to comprehensively compare these 4 surgical methods using a network meta-analysis. The authors systematically searched MEDLINE, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for studies that evaluated at least 2 of the following pancreatectomy techniques: robot-assisted DP, laparoscopic DP, open DP, and robotic DP. The surface under the cumulative ranking curve (SUCRA) was applied to show the probability that each method would be the best for each outcome. Altogether, 46 trials with 8377 patients were included in this network meta-analysis. Robotic DP showed the highest probability of having the least estimated blood loss (SUCRA, 90.9%), the lowest incidences of postoperative pancreatic fistula (SUCRA, 94.5%), clinically related postoperative pancreatic fistula (SUCRA, 94.6%), postoperative bleeding (SUCRA, 75.3%), reoperation (SUCRA, 96.4%), overall complications (SUCRA, 86.9%), and major complications (SUCRA, 99.3%), and the lowest mortality (SUCRA, 83.4%). Robotic DP also proved to be the best approach regarding the attainment of R0 resection (SUCRA, 75.4%) and the number of lymph nodes harvested (SUCRA, 64.1%). Robotic DP seems to offer clinical and oncological advantages compared with other DP methods for addressing diseases of the pancreatic body and tail, although it may require a longer operation time and learning curve. The present results require confirmation in future head-to-head randomized controlled trials.

Robot-assisted distal pancreatectomy improves spleen preservation rate versus laparoscopic distal pancreatectomy for benign and low-grade malignant lesions of the pancreas.

BackgroundThe aim of this retrospective study was to compare robot-assisted distal pancreatectomy (RDP) with laparoscopic distal pancreatectomy (LDP) for patients with benign and low-grade malignant lesions of the pancreas.MethodsThis study included 166 patients who underwent RDP (n=63) or LDP (n=103) for benign or low-grade malignant lesions of the pancreas from January 2011 to October 2018 in Changhai Hospital. A retrospective analysis was performed between the two groups. The primary points were operation time, operative blood loss, hospital stay, pancreatic fistula and spleen preservation.ResultsThere were no significant differences in patient characteristics or indications between RDP and LDP. Notably, among all patients, RDP was associated with a significantly higher rate of spleen preservation than that for LDP (30.2% vs. 6.8%, P<0.001), while other intraoperative variables were similar between the two groups. No death cases in the study group within 30 days were reported in either group. Referring to postoperative outcomes, postoperative pancreatic fistula (POPF) was 22% for the RDP group and 33% for the LDP group. In addition, the rate of clinically significant grade B/C pancreatic fistula was 5% and 7%, respectively. There were also no significant differences in hospital stay (6.0±3.0 vs. 6.4±2.5, P=0.404). Furthermore, the univariate analysis demonstrated that tumor size (P=0.001) and surgery group (RDP/LDP) (P=0.002) were associated with SP rate independent factor for spleen preservation.ConclusionsRDP is an effective and safe technique with significant advantage in spleen preservation for patients with benign and low-grade malignant lesions in the distal pancreas.

Up-to-date comparison of robotic-assisted versus open distal pancreatectomy: A PRISMA-compliant meta-analysis.

Although robot-assisted distal pancreatectomy (RADP) has been successfully performed since 2003, its advantages over open distal pancreatectomy (ODP) are still uncertain. The objective of this meta-analysis is to compare the clinical and oncologic safety and efficacy of RADP vs ODP. Multiple databases (PubMed, Medline, EMBASE, Web of Science, and Cochrane Library) were searched to identify studies that compare the outcomes of RADP and ODP (up to February, 2020). Fixed and random effects models were applied according to different conditions. A total of 7 studies from high-volume robotic surgery centers comprising 2264 patients were included finally. Compared with ODP, RADP was associated with lower estimated blood loss, lower blood transfusion rate, lower postoperative mortality rate, and shorter length of hospital stay. No significant difference was observed in operating time, the number of lymph nodes harvested, positive margin rate, spleen preservation rate, rate of severe morbidity, incidence of postoperative pancreatic fistula, and severe postoperative pancreatic fistula (grade B and C) between the 2 groups. With regard to perioperative outcomes, RADP is a safe and feasible alternative to ODP in centers with expertise in robotic surgery. However, the evidence is limited and more randomized controlled trials are needed to further clearly define this role.

The Safety and Feasibility of&amp;nbsp;Robot-Assisted Pancreatic Surgery at&amp;nbsp;a High-Volume Center: A Nine-Year Retrospective Single-Center Analysis of 1396 Patients

Objective: We aimed to share our experience with 1396 cases of robot-assisted pancreatic surgery (RAPS) over nine years. Methods:The medical records of 1396 patients who underwent RAPS between May 2010 and December 2018 at Shanghai Ruijin Hospital were retrospectively analyzed. Operative outcomes, including the operative duration, estimated blood loss (EBL), and incidence of morbidities, especially postoperative pancreatic fistula (POPF), are discussed. We also recorded and illustrate our progress along the learning curve for RAPS in this large cohort. Results: During the study period, 1396 patients underwent RAPS at our center. Among them, 450 patients underwent robot-assisted pancreaticoduodenectomy (RPD), 605 patients underwent robot-assisted distal pancreatectomy (RDP), 144 patients underwent robot-assisted middle pancreatectomy (RMP), 119 patients underwent robot-assisted enucleation (REn), 40 patients underwent robot-assisted duodenum-preserving pancreatic head resection (R-DPPHR), 12 patients underwent robot-assisted total pancreatectomy (R-TP) and 26 patients underwent other types of surgery with a robot-assisted platform. A total of 442 patients (31.7%) suffered malignant tumors, while 357 (25.6%) patients had pancreatic ductal adenocarcinoma (PDAC). The mean operative duration was 195.3±107.4 min. The mean EBL was 197.5±107.4 ml. There were a total of 13 cases (0.9%) of conversion to open surgery due to adhesion and vascular invasion by the tumor. The total incidence rate of complications was 39.1% (546/1396). The incidence rate of clinically related (CR)-POPF of the total cohort was 16.5% (230 patients). The mean postoperative length of hospital stay (LOS) of the total cohort was 20.0±12.9 days. Conclusions: To the best of our knowledge, this is the largest sample size of RAPS cases ever reported. In conclusion, for benign and low-grade malignant pancreatic tumors, minimally invasive pancreatic surgery is safe and feasible and might be a good choice. Operative outcomes improve with accumulated experience. Further prospective analyses of RAPS should be designed to verify the advantages of RAPS. Funding Statement: The study was funded by National Natural Science Foundation of China (NSFC) directly to Baiyong Shen. Serial number: 81871906. It was also sponsored bu the Interdisciplinary Program of Shanghai Jiao Tong University directly to Jiabin Jin. Serial number: YG2019QNB26. Declaration of Interests: All the authors, Dr Yusheng Shi, Dr Jiabin Jin, Dr Junjie Xie, Dr Yuanchi Weng, Dr Mengmin Chen, Dr Kai Qin, Dr Hao Chen, Dr Xiaxing Deng, Dr Baiyong Shen and Dr Chenghong Peng have no conflicts or financial ties to disclose. Ethics Approval Statement: This retrospective study was approved by the institutional review board of Shanghai Ruijin Hospital. Every patient provided written informed consent to undergo the operation and for the use of the data we collected before and after the surgery.

Full Robotic Distal Pancreatectomy: Safety and Feasibility Analysis of a Multicenter Cohort of 236 Patients.

Introduction. Despite the widespread use of the robotic technology, only a few studies with small sample sizes report its application to pancreatic diseases treatment. Our aim is to present the results of a multicenter study on the safety and feasibility of robot-assisted distal pancreatectomy (RDP). Materials and Methods. All RDPs for benign, borderline, and malignant diseases performed in 5 referral centers from 2008 to 2016 were included. Perioperative outcomes were evaluated. Results. Two hundred thirty-six patients were included. Spleen preservation was performed in 114 cases (48.3%). Operative time was 277.8 ± 93.6 minutes. Progressive improvement in operative time was observed over the study period. Conversion rate was 6.3%. Morbidity occurred in 102 cases (43.2%), mainly due to grade A fistulas. Reoperation was required in 10 patients. Postoperatively, 2 patients died of sepsis due to a grade C fistula. Hospital readmission was necessary in 11 cases. A R0 resection was always achieved, with a mean number of 16.2 ± 15 harvested lymph nodes. Conclusion. To our knowledge, this is one of the largest RDP series. Safety and feasibility including the low conversion rate, the high spleen preservation rate, the adequate operative time, and the acceptable morbidity and mortality rates confirm the validity of this technique. Appropriate oncological outcomes have been also obtained.

Procedure-specific Training for Robot-assisted Distal Pancreatectomy.

To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared "before training" (ODP only; <June 2012) and "after training" (RADP and ODP; >June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensity-score-matched (1:1) analysis to determine clinical efficacy. After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (-255 mL, P<0.001), OT increased (+65 min, P < 0.001), and median LOS decreased (-1 day, P < 0.001). All other outcomes remained similar (P>0.05). Over time, there were nonrandom (P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (<31 cases), optimization (case 31-65), and a steady-state (>65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP. Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety.

Transversus abdominis plane block reduces pain and narcotic consumption after robot-assisted distal pancreatectomy

BackgroundMinimizing pain and disability are key postoperative objectives of robot-assisted distal pancreatectomy (RADP). This study tested effects of bupivacaine transversus abdominis plane (TAP) block on opioid consumption and pain after RADP. MethodsRetrospective case-control study (June 2012 -Oct 2017) evaluating bilateral intraoperative bupivacaine TAP block as an interrupted time series. Linear regression evaluated opioid consumption in terms of intravenous (IV) morphine milligram equivalents (MME) and controlled for preoperative morbidity. Secondary outcomes included numerical rating scale (NRS) pain scores. Results81 RADP patients met eligibility, 48 before and 33 after implementation of TAP. Baseline characteristics were equivalent with a trend toward higher age, Charlson comorbidity, and ASA score among the TAP cohort. TAP patients consumed on average 4.52 fewer IV MME than controls during the first six postoperative hours (p = 0.032) and reported lower mean NRS scores at six (p = 0.009) and 12 h (p = 0.006) but not at 24 h (p = 0.129). Postoperative morbidity and lengths of stay (LOS) were equivalent (5 vs. 6 days, p = 0.428). ConclusionBupivacaine TAP block was associated with significant reductions in opioid consumption and pain after RADP but did not shorten hospital LOS consistent with bupivacaine's limited half-life.

Mo1265 - Transversus Abdominis Plane Block Reduces Narcotic Use and Pain after Robot-Assisted Distal Pancreatectomy

Mo1265 - Transversus Abdominis Plane Block Reduces Narcotic Use and Pain after Robot-Assisted Distal Pancreatectomy

Experience of Laparoscopic and Robot-assisted Distal Pancreatectomy

Aim. To analyze the outcomes of robot-assisted and laparoscopic distal pancreatectomies. Material and Methods. 42 patients were enrolled: 27 patients underwent laparoscopic distal pancreatectomy, 15 – robot-assisted distal pancreatectomy. Results . Both groups were statistically homogeneous and comparable. Time of laparoscopic and robot-assisted distal pancreatectomy was 184 ± 21.4 and 236 ± 31.6 min (p = 0.0384), respectively; intraoperative blood loss – 310 ± 54 ml and 240 ± 86 ml (p = 0.0564), respectively. There were 6 (66.7%) spleen-sparing laparoscopic distal pancreatectomies and 6 (85.7%) robotic procedures in the same fashion. The length of hospital-stay after laparoscopy was 5.4 ± 1.8 days, after robot-assisted operation – 6.1 ± 1.6 days (p = 0.073). The number of hemorrhagic complications and pancreatic fistulas ISGPS 2016 was similar in both groups. There were 16 Clavien–Dindo complications after laparoscopic pancreatectomy and 8 after robot-assisted surgery. Conclusion . It was established that laparoscopic pancreatectomy is associated with reduced time of surgery and lower percentage of spleen-sparing interventions. Intraoperative blood loss, hospital-stay and postoperative morbidity do not depend on the type of surgery.