Robotic Pancreatic Surgery Research Articles

Robotic-Assisted Pancreaticoduodenectomy With Vascular Resection: Our Initial Experience

Introduction: Firstly described in 2003, the widespread of robotic pancreaticoduodenectomy (PD) is still slow. The complexity of the procedure, the higher cost of this technology and the lack of a specific training confined this procedure to high-selected centres. We investigated the perioperative outcomes of our experience in robotic PD including patients who underwent to resection and reconstruction of superior mesenteric/portal vein (PD-SMV/PV) in order to evaluate the safety and feasibility of this approach. Method: We performed a retrospective analysis from January 2015 to April 2018 of our prospectively maintained database on robotic pancreatic surgery. Result: A total of 55 patients (28 male – 27 female) during the time period evaluated underwent to robotic PD. We performed 45 robotic PD and 10 robotic PD-SMV/PV. The overall operative time was 425 min (290-550), with a reduction over the course of learning curve, while the median blood loss was 170 ml (30-700). We observed a low conversion rate 5/55 (9 %) and an acceptable overall postoperative morbidity rate of 12/55 (21.8%), 6 of which belong to groups III-V according to Clavien-Dindo score. The pancreatic fistula rate was 9/55 (16.4 %), but only 3 (5.5%) clinically significant. We achieved a R0 resection rate in 51/55 (92.7%) of patients with a mean lymph nodes retrieved of 20.5 (17-25). The reoperation rate for all series was low 6/55 (10.9%) as well as the 90-day mortality rate 3/55 (5.5%). Conclusion: Despite our initial learning curve, the robotic approach seems to be safe and effective giving some potential advantages in terms of estimated blood loss and conversion rate, preserving a good oncologic adequacy. The long-term oncologic outcomes and the cost-effectiveness of this approach needs instead further investigations.

Outcomes associated with robotic approach to pancreatic resections.

Minimally invasive techniques have improved post-operative outcomes, however, the majority of pancreatic surgery, known for its complexity, is still performed via open approaches. The development of robotics has improved dexterity which may allow for application in more complex surgeries. We queried a prospectively maintained robotic database to identify patients who underwent robotic pancreatic resection by a single surgeon between 2012 and 2016. Patient demographics and operative outcomes were compared using Mann-Whitney U, Kruskal Wallis and Pearson's Chi-square test as appropriate. We identified 119 patients; 65 Whipples [Robotic Whipple (RW)], 43 distal pancreatectomies, 4 total pancreatectomies, 6 pancreatic enucleations, and 1 robotic cyst gastrostomy with a median age of 71 [24-91], median body mass index (BMI) of 27.6 (16.8-40.2), and American society of anesthesiologists (ASA) of 3. The median estimated blood loss (EBL) was 125 [25-800] and loss of heterozygosity (LOH) 6 [1-34]. Mean operative time for RW decreased after 15 cases (578 vs. 457 minutes, P<0.004). Conversions to open occurred in 5 (4.2%) patients. In total of 117 (98.3%) patients underwent R0 resections and the median lymph node (LN) harvest was 16 [0-37]. The 30 and 90 days mortality was 1 (0.8%). Major complications (Clavien-Dindo grade 3-5) were seen in 16 (13.4%) cases (20.3%) but decreased steadily as volume increased (case 30). Pancreatic leaks occurred in 14 (11.8%): A, 8 (6.7%); B, 4 (3.4%); and C, 2 (1.7%). Robotic assisted approaches to pancreatic resections is feasible. However, it takes approximately 15 cases before a decrease in operative time and 30 cases before major complications are decreased. These trends in complications are associated with surgeon experience and volume are critical to consider in robotic pancreatic surgery.

Trends in Robotic Pancreaticoduodenectomy and Distal Pancreatectomy.

Pancreatic surgery remains a challenge even to the most experienced surgeons. Despite significant advances in the field, morbidity and mortality continue to have elevated rates even in specialized, high-volume centers. The rise of laparoscopy in the past decades has improved outcomes for patients, but remains unused due to the technical complexities involved. A literature search was performed using PubMed and Google Scholar databases. Key words used in the search include: "robotic surgery," "robotic pancreas surgery," "pancreas surgery," "minimally invasive pancreas surgery," "robotic pancreaticoduodenectomy," and "robotic distal pancreatectomy." The studies included in our review were summarized in a patient intervention comparison and outcome table. The use of a robotic platform has emerged to counteract the more challenging aspects of laparoscopic pancreatic surgery, but incurs a high cost. Data, however, show a trend toward ever improving outcomes such as operative time, estimated blood loss, and length of stay, while still offering the benefits of minimally invasive surgery. There is no question that the use of robots in surgery will continue to expand, and with this, appropriate measures must be taken to ensure patient safety in the form of standardized education and certification for the future generation of surgeons considering robotic surgery. As robotic pancreatic surgery grows, encouraging data have emerged-as surgeons become more skilled and programs gain experience, patients are being benefited by this expanding technology. Larger, prospective cohorts will also provide more definitive evidence of the benefits of robotic surgery.

The robotic-assisted pancreaticoduodenectomy with vascular reconstruction: our personal experience

Introduction: Firstly described in 2003, the widespread of robotic pancreaticoduodenectomy (PD) is still slow. The complexity of the procedure, the higher cost of this technology and the lack of a specific training confined this procedure to high-selected centres. We investigated the perioperative outcomes of our first 50 robotic PD including our initial experience with resection and reconstruction of superior mesenteric/portal vein (PD-SMV/PV) in order to evaluate the safety and feasibility of this approach. Methods: We performed a retrospective analysis from January 2012 to April 2017 of our prospectively maintained database on robotic pancreatic surgery. Results: A total of 50 patients during the time period evaluated underwent to robotic PD. We performed 45 robotic PD and 5 robotic PD-SMV/PV. The overall operative time was 425 min (290–550), with a reduction over the course of learning curve, while the median blood loss was 170 ml (30–700). We observed a low conversion rate 5/50 (10%) and an acceptable overall postoperative morbidity rate of 12/50 (24%). The pancreatic fistula rate was 8/50 (16 %), but only 3 (6%) clinically significant. We achieved a R0 resection rate in 46/50 (92%) of patients with a mean lymph nodes retrieved of 20.5 (17–25). The reoperation rate for all series was low 6/50 (12%) as well as the 90-day mortality rate 3/50 (6%). Conclusions: Despite our initial learning curve, the robotic approach seems to be safe and effective giving some potential advantages in terms of estimated blood loss and conversion rate, preserving a good oncologic adequacy.

Preliminary clinical experience with robotic retroperitoneoscopic pancreatic surgery

BackgroundsRetroperitoneoscopic surgery has shown advantages in urological surgery. However, its application in pancreatic surgery for neoplasm is rare. Robotic surgical system with its magnified view and flexible instruments may provide a superior alternative to conventional laparoscopic system in retroperitoneoscopic surgery. We aimed to evaluate the safety, feasibility, and short-term outcomes in a series of patients treated by robotic retroperitoneoscopic pancreatic surgery.Case presentationBetween March 2016 and May 2016, four patients with solitary pancreatic neuroendocrine neoplasms were treated with robotic retroperitoneoscopic surgery. Prospective collected clinical data were retrospectively analyzed. Three patients underwent distal pancreatectomy (one combined with resection of left adrenal adenoma), and one patient enucleation. The mean operative time was 80 min (range 30–110 min). The estimated blood loss was insignificant. There was no conversion to open procedure. The mean postoperative hospital stay was 5.25 days (range 4–6 days). The mean tumor size was 1.375 cm (range 1.0–1.8 cm) in diameter. All patients’ blood glucose level returned to normal range within 1 week postoperatively. Two patients had pancreatic biochemical leak. No patients underwent subsequent treatment, and no recurrence occurred during the 12-month follow-up period.ConclusionsThis study preliminarily indicates that robotic retroperitoneoscopic pancreatic surgery is safe and feasible for neoplasms in the dorsal portion of distal pancreas in selected patients, with some potential advantages of straightforward access, simple and fine manipulation, short operative time, and fast recovery.

Complications after robotic pancreatic surgery our experience

Complications after robotic pancreatic surgery our experience

Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy.

Is robotic pancreatectomy indicated for patients with pancreatic cancer?

Minimally invasive pancreatic surgery (MIPS) is becoming more popular in the recent years. Robotic pancreatic surgery represents an important step, mostly for Whipple procedures, in order to reproduce the same surgical steps performed in open surgery and to facilitate the access to MIPS even by surgeons without a large experience in laparoscopic surgery. The short-term results of pancreatic robotic surgery are comparable with the one obtained by the traditional open surgery, even if the peri-operative costs, still represent a problem. Very few data are currently available regarding the long-term oncologic outcome of robotic pancreatectomy for pancreatic cancer. For this reason, more and larger studies, with a long follow-up are necessary to define the oncologic role and safety of robotic pancreatectomies.

Robotic pancreatic surgery: old concerns, new perspectives

Background: Described for the first time in 2003, the robotic pancreatic surgery shows interesting results. The evaluation of post-operative outcomes is necessary once we describe an innovative surgical approach.Methods: We have performed a retrospective analysis of a prospectively maintained database on robotic pancreatic surgery including malignant and benign indications for surgery.Results: A total of 50 consecutive patients underwent robotic pancreatic surgery (26 pancreatico duodenectomy and 24 distal pancreatectomy) between January 2012 and July 2015 in a single centre. The overall operative time was 425 (390–620) min. In a subgroup of highly selected malignant tumours, we were able to achieve 88% of R0 resection with robotic approach. A number of lymphnodes rose significantly with growing experience (p = .025). The overall major complication rate (15%), as well as pancreatic fistula rate (16%) were acceptable. The two-year overall survival for the whole group was 65%.Conclusion: The robotic pancreatic surgery in a highly selected group of patients seems safe and feasible. The cost-effectiveness and long-term oncologic outcomes need further investigations.

Application of a commercial single-port device for robotic single-incision distal pancreatectomy: initial experience.

Laparoscopic distal pancreatectomy has proven to be feasible and safe. Moreover, robotic surgery provides unique advantages for pancreatic procedures, although single-incision robotic pancreatic surgery is rarely discussed. We applied the single-port modified platform to accomplish robotic distal pancreatectomy in a series of patients. The subjects of this study were ten patients who underwent robotic distal pancreatectomy in our hospital between July 1, 2015 and Dec 31, 2016. All patients were placed supine in the reverse Trendelenburg position with the legs abducted. Surgery was performed via a trans-umbilical 5.0-cm incision, using a modified single-port platform (LAGIPORT®) combined with the da Vinci Si Surgical System. The three arms and scope (30-degree up) were inserted through the LAGIPORT® and positioned in a triangle. Endoscopic ultrasound was used to localize the tumor and plan the resection margin. We recorded the surgical time, operation time, blood loss, postoperative pain score, hospital stay, and complications. The surgical time was 236 ± 32min, the operation time was 172 ± 30min, and the blood loss was 149 ± 65ml. All patients underwent robot-assisted distal pancreatectomy without conversion. The average pain score on postoperative day (POD) 3 was 4.5 ± 1. Complications included subsplenic hematoma (n = 1) and minor pancreatic leakage (n = 2). There was no surgical mortality. Our results demonstrate the safety and efficiency of robotic single-incision distal pancreatectomy via the modified platform (LAGIPORT®).

A single-team experience with robotic pancreatic surgery in 1010 cases

To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases. The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system. The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017. This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.

Surgical resection of pancreatic neuroendocrine neoplasm by minimally invasive surgery—the robotic approach?

Over the past decade, there has been increasing adoption of minimally invasive pancreatic surgery world-wide and this has naturally expanded to the management of pancreatic neuroendocrine neoplasms (PNENs). More recently, robotic pancreatic surgery (RPS) was introduced to overcome the limitations during laparoscopic pancreatic surgery (LPS). Due to the relative rarity of PNEN and the novelty of minimally invasive pancreatic surgery in particular RPS today, the evidence for robotic surgery in PNENs remains extremely limited. Presently, the available evidence is limited to a few low level retrospective case-control studies. These studies suggest that RPS may be associated with a higher splenic preservation rates and lower open conversion rates compared to conventional laparoscopic surgery. Ideally a prospective randomized trial should be performed but this would be extremely challenging due to the rarity of PNEN, making it almost impossible to conduct a sufficiently powered trial.

Role of robotic-assisted pancreatic surgery: lessons learned from our initial experience

Minimally invasive surgery has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. In fact, the indication for robotic surgery in pancreatic disease has been controversial. The present study aimed to assess the safety and feasibility of robotic pancreatic resection. We retrospectively reviewed our experience of robotic pancreatic resection done in Sanchinarro University Hospital. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed. From October 2010 to April 2016, 50 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 50 patients, 26 were male and 24 female. The average age of all patients was 62 years. Operative time was 370 minutes. Among the procedures performed were 16 pancreaticoduodenectomies (PD), 23 distal pan-createctomies (DP), 11 tumor enucleations (TE). The mean hospital stay was 17.6 days in PD group, 9.0 days in DP group and 8.4 days in TE group. Pancreatic fistula occurred in 10 cases (20%), 2 after PD, 3 after DP, and 5 after TE. Four patients had postoperative transfusion in PD group and one in DP group. Conversion to open laparotomy occurred in four patients (8%). No serious intraoperative complications were observed. From our early experience, robotic pancreatic surgery is a safe and feasible procedure. Further experience and follow-up are required to confirm the role of robotic approach in pancreatic surgery.

Robotic pancreatic surgery: our initial experience

Robotic pancreatic surgery: our initial experience

ROBOT-ASSISTED PANCREATIC SURGERY (REVIEW)

Aim. To systematize world literature data for robot-assisted pancreatic surgery. Material and methods. 31 publications for the period 2010–2014 were analyzed. In these articles 856 robot-assisted pancreatic operations were assessed. Results. 90% of robot-assisted pancreatic operations include pancreaticoduodenectomy (55%) and distal pancreatectomy (35%). Median time of robot-assisted pancreatoduodenectomy was 342 ± 209 minutes, distal pancreatectomy time – 200 ± 131.9 minutes. Median blood loss during robot - assisted operations was referred to class 1 by WHO (2001) classification. The number of complications is increased as far as the number of robotic assisted operations is augmented. Conclusion. Analyses demonstrates growing interest of pancreatic surgeons in robotic technologies. At the same time there is no unique strategy of robotic pancreatic surgery. Certain indications and contraindications for pancreatic robotassisted surgery are absent. There is no methodological base describing technical aspects of these difficult interventions. So, further researches of robot-assisted techniques are advisable to eliminate these limitations.

Robotic (computer assisted) pancreatic surgery: A real innovation?

Robotic (computer assisted) pancreatic surgery: A real innovation?

Impact of Obesity on Robot-Assisted Distal Pancreatectomy.

Obesity has been steadily increasing in the United States. The effect of body mass index (BMI) on surgical outcomes in pancreatic surgery is still controversial. Currently, there is no report related to obesity and robotic pancreatic surgery. The purpose of this study was to evaluate the impact of BMI on the surgical outcomes of both nonobese and obese patients undergoing robot-assisted distal pancreatectomy (RADP). A prospectively collected database for RADP was retrieved for analysis. Patients were categorized as obese (BMI ≥30 kg/m(2)) and nonobese (BMI <30 kg/m(2)). Demographics, perioperative data, American Society of Anesthesiologists score, diagnosis, conversion rate, morbidity, surgical mortality, pancreatic fistula rate, and length of stay were compared. A total for 85 RADP were included, with 57 (67%) in the nonobese group and 28 (33%) in the obese group. No differences were found between nonobese and obese patients regarding demographic, preoperative risk, and perioperative parameters and mortality. There was a trend in the obese group associated with a higher rate of postoperative complications, but it was statistically insignificant. Clinically significant pancreatic fistula (grade B) occurred in 28.5% of obese patients and in 7% of nonobese patients, but without statistical significance (P = .064). Obesity does not have a significant impact on the perioperative outcomes and surgical risks for patients undergoing RADP, but high BMI may be a predictor for pancreatic fistula after RADP.

Experience in selecting patients to undergo robotic pancreatic surgery

Objective To review our initial experience in selecting patients to undergo robotic pancreatic surgery. Methods This is a retrospective study on 100 patients who underwent robotic pancreatic operations at the Chinese PLA General Hospital from September 2009 to March 2015. Results 89 patients underwent robotic pancreatic body and tail resection, 5 patients superficial enucleation of pancreatic lesions, 3 patients middle pancreatic resection, 1 patient pancreaticoduodenectomy, 1 patient pancreatico-gastric ana-stomosis, and 1 patient pancreatico-jejunal anastomosis. Conclusions Robotic pancreatic surgery was safe and feasible. Lesions located in pancreatic body and tail could be treated with resection of pancreatic body and tail, and this appeared to be the best indication for robotic pancreatic surgery. Focal lesions on the surface of pancreas could be enucleated using the Da Vinci robotic surgical system. Extreme care should be exercised in selecting patients for robotic pancreaticoduodenectomy, because the surgical risk is high. Key words: Da Vinci robotic surgical system; Pancreatic operation; Indication

Initial Experience With Robotic Pancreatic Surgery

Robotic surgery has been introduced in the field of minimally invasive surgery to improve the handling of high-demanding procedures with encouraging results. We aimed to evaluate the clinical safety and the oncological adequacy of robot-assisted pancreatic surgery by analyzing a consecutive series in terms of surgical and oncological outcomes. A total of 53 consecutive cases including 36 pancreatoduodenectomies (PD) and 14 distal pancreatectomies (DP) were evaluated. The overall postoperative morbidity and mortality were 32% and 3.8%, respectively. Radical resection was achieved in 93.7% of PD and 100% of DP, with a mean number of harvested lymph nodes of 29.8 for PD and 20.5 for DP. The 3-year cumulative overall survival was 44.2% and 73.9% for patient with pancreatic ductal adenocarcinoma and nonductal malignancy, respectively. Robotic technology may be useful to reproduce conventional open pancreatic surgery with a minimally invasive approach, overcoming some of the intrinsic limitations of conventional laparoscopy.

Is Robotic Pancreatic Surgery A Gamechanger?

Is Robotic Pancreatic Surgery A Gamechanger?