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Xu WY, Xin J, Yang Y, Wang QW, Yuan BH, Peng FX. A comprehensive analysis of robotic assisted vs. laparoscopic distal pancreatectomy using propensity score matching. J Robot Surg 2025; 19:86. [PMID: 40014153 DOI: 10.1007/s11701-025-02249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 02/16/2025] [Indexed: 02/28/2025]
Abstract
Using the propensity-matched methodology, this meta-analysis and comprehensive review aimed to compare robotic distal pancreatectomy with laparoscopic distal pancreatectomy in terms of perioperative and short-term oncologic outcomes. Within the scope of this investigation, complete and total adherence to the PRISMA guidelines for Systematic Reviews and Meta-Analyses was established. The search we conducted in PubMed, Google Scholar, and EMBASE was automated to find relevant papers that matched the tendency up to July 1, 2024. The length of time spent while operating, the rate of conversion, and the collection of lymph nodes were the primary factors that were considered. Other metrics that were taken into consideration were the approximate amount of blood loss, the length of time spent in the hospital, the need for transfusions, and the occurrence of major adverse events. In the end, there were 8 studies that involved 1649 patients. Of those patients, 758 had robotic assisted distal pancreatectomy, whereas 891 underwent laparoscopic distal pancreatectomy. In comparison to laparoscopic distal pancreatectomy, the robotic assisted technique did result in higher anticipated blood loss and conversion rates; however, it also required longer durations of operation due to its lengthier duration. In terms of lymph node retrieval, the duration of hospital stay, the need for blood transfusions, and the incidence of postoperative pancreatic fistula, there were no distinctions that could be considered statistically significant between the two techniques. A realistic and risk-free surgical alternative is a distal pancreatectomy that is performed with the aid of robotic technology. When compared to laparoscopic surgery, the outcomes of robot-assisted surgery were superior in terms of conversion rates to laparotomy and less anticipated intraoperative blood loss. However, the operation took longer to complete than laparoscopic surgery.
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Affiliation(s)
- Wan-Yu Xu
- North Sichuan Medical College, Nanchong, China
- Department of General Surgery, 404 Hospital, Mianyang City, Sichuan Province, China
| | - Jiang Xin
- North Sichuan Medical College, Nanchong, China
| | - Young Yang
- North Sichuan Medical College, Nanchong, China
| | | | | | - Fang-Xing Peng
- Department of General Surgery, 404 Hospital, Mianyang City, Sichuan Province, China.
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Guerra F, Giuliani G, Salvischiani L, Genovese A, Coratti A. Minimally Invasive Pauli Parastomal Hernia Repair. Surg Laparosc Endosc Percutan Tech 2024; 34:647-651. [PMID: 39434215 DOI: 10.1097/sle.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 09/20/2024] [Indexed: 10/23/2024]
Abstract
BACKGROUND Although originally described as an open procedure, the application in the setting of minimally invasive surgery of the Pauli technique for parastomal hernia repair is gaining interest among surgeons owing to encouraging early results. We aimed at combining and analyzing the results of minimally invasive Pauli repair by assessing the available evidence. METHODS A literature search in Pubmed, Embase, and Web of Science was undertaken to include all articles reporting on minimally invasive repair of parastomal hernias using the Pauli technique. RESULTS Data regarding a total of 75 patients across 11 articles published between 2019 and 2023 were included. Patients received surgery either by a laparoscopic (27%) or robotic (73%) approach. A transabdominal route was chosen in 62 patients (83%), while an extraperitoneal technique was employed in the remaining 13 patients. The rate of postoperative morbidity was 34%, with 10% being the incidence of grade >II complications. The reported overall rate of recurrence was 7% at a median follow-up of 1 to 43 months. CONCLUSIONS The available evidence derived from a growing number of centers suggests that minimally invasive Pauli repair is a viable option to treat parastomal hernias. Despite robust, high-level data still lacking, preliminary experiences indicate promising results.
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Yin ZZ, Gao YX, Zhao ZM, Hu MG, Tang WB, Liu R. Robotic versus laparoscopic surgery for sporadic benign insulinoma: Short- and long-term outcomes. Hepatobiliary Pancreat Dis Int 2024; 23:399-405. [PMID: 37423832 DOI: 10.1016/j.hbpd.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Minimally invasive surgery is the optimal treatment for insulinoma. The present study aimed to compare short- and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma. METHODS A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted. The demographic, perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups. RESULTS A total of 85 patients were enrolled, including 36 with laparoscopic approach and 49 with robotic approach. Enucleation was the preferred surgical procedure. Fifty-nine patients (69.4%) underwent enucleation; among them, 26 and 33 patients underwent laparoscopic and robotic surgery, respectively. Robotic enucleation had a lower conversion rate to laparotomy (0 vs. 19.2%, P = 0.013), shorter operative time (102.0 vs. 145.5 min, P = 0.008) and shorter postoperative hospital stay (6.0 vs. 8.5 d, P = 0.002) than laparoscopic enucleation. There were no differences between the groups in terms of intraoperative blood loss, the rates of postoperative pancreatic fistula and complications. After a median follow-up of 65 months, two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence. CONCLUSIONS Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time, which might lead to a reduction in postoperative hospital stay.
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Affiliation(s)
- Zhu-Zeng Yin
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yuan-Xing Gao
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi-Ming Zhao
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Ming-Gen Hu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Bo Tang
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China.
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Guerra F, Marra U, Giuliani G, Coratti A. Robotic Extended Ultrasound-Guided Distal Pancreatectomy for Pancreatic Metastases from Uveal Melanoma. Ann Surg Oncol 2022; 29:2469-2470. [PMID: 34839428 DOI: 10.1245/s10434-021-11116-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Isolated pancreatic metastasis from melanoma is extremely uncommon and accounts for approximately only 2% of visceral disseminations of melanoma.1-3 Interestingly, pancreatic localizations disproportionately derive from primary ocular melanoma.1,2 Despite the currently available evidence on this argument being scarce, the survival outcomes of patients receiving resection for visceral melanoma metastases are reported to be superior than those managed by non-surgical modalities.4,5 CASE PRESENTATION: A 59-year-old female with a history of uveal melanoma presented with surveillance-detected metastatic disease confined to the pancreas. Computed tomography demonstrated one lesion located in the body of the pancreas and one further lesion in the head. The presented video illustrates the details of an extended, ultrasound-guided, robotic distal pancreatectomy. DISCUSSION Metastatic ocular melanoma has a highly variable natural history, which ranges from a fulminant course to prolonged stable disease.6 In contrast to cutaneous melanoma derivation, metastases mostly occur via hematogenous spread, in the absence of lymphatic drainage of the eye.6,7 Liver is the most common site of secondary localization and is not involved by metastatic disease in <10% of cases. Interestingly, patients with extrahepatic metastases tend to have significantly better survival rates than those with hepatic disease.6,7 Fewer than 100 cases of pancreatic metastasis from malignant melanoma are reported in the medical literature, including a relatively high percentage of primary ocular malignancies.1,5 Furthermore, the prognosis of these patients is essentially unknown, although metastatic melanoma of both cutaneous and ocular origin generally indicates poor survival.1,5,6 Although no robust evidence is available, a number of reports suggest that pancreatic resection may improve survival in these patients.1-4 A large retrospective review investigating the association between treatment modalities and survival of patients with abdominal visceral melanoma metastases showed that patients receiving resection had a superior median survival compared with patients treated medically. Although patients with metastases of the gastrointestinal tract showed the best outcomes following surgery, patients with pancreas metastasis (of both cutaneous and ocular origin) undergoing resection also exhibited a significant survival advantage compared with those treated non-surgically.5 Minimally invasive pancreatectomy is gaining momentum.8 In fact, in selected patients there are distinct advantages compared with conventional surgery owing to reduced postoperative morbidity and earlier return to daily activities, while maintaining the oncological tenets of resection.8-10 Recent reports suggest that the application of robots may provide some advantages over conventional laparoscopy, especially for patients necessitating technically challenging surgeries.8,11 Such benefits are mainly in relation to the rate of conversion, length of postoperative hospital stay, and number of cases necessary to surmount the learning curve and reach optimal performance; however, no definitive conclusions can be drawn due to the lack of high-level evidence.8,10.
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Giuliani G, Guerra F, Coletta D, Giuliani A, Salvischiani L, Tribuzi A, Caravaglios G, Genovese A, Coratti A. Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis. Int J Colorectal Dis 2022; 37:101-109. [PMID: 34599362 DOI: 10.1007/s00384-021-04038-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Minimally invasive surgery has been universally accepted as a valid option for the treatment of diverticular disease, provided specific expertise is available. Over the last decade, there has been a growing interest in the application of robotic approaches for diverticular disease. We aimed at evaluating whether robotic colectomy may offer some advantages over the laparoscopic approach for surgical treatment of diverticular disease by meta-analyzing the available data from the medical literature. METHODS The PubMed/Medline, EMBASE, and Web Of Sciences electronic databases were searched for literature up to December 2020. Inclusion criteria considered all comparative studies evaluating robotic versus laparoscopic colectomy for diverticulitis eligible. The conversion rate to the open approach was evaluated as the primary outcome. RESULTS The data of 4177 patients from nine studies were included in the analysis. There were no significant differences in the baseline characteristics. Patients undergoing laparoscopic colectomy compared to those who underwent surgery with a robotic approach had a significantly higher risk of conversion into an open procedure (12.5% vs. 7.4%, p < 0.00001) and abbreviated hospital stay (p < 0.0001) at the price of a longer operating time (p < 0.00001). CONCLUSION Compared with conventional laparoscopic surgery, the robotic approach offers significant advantages in terms of conversion rate and shortened hospital stay for the treatment of diverticular disease. However, because of the lack of available evidence, it is impossible to draw definitive conclusions.
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Affiliation(s)
- Giuseppe Giuliani
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy.
| | - Francesco Guerra
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Emergency Department - Emergency and Trauma Surgery Unit, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lucia Salvischiani
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Angela Tribuzi
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Giuseppe Caravaglios
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Alfredo Genovese
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
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Kwon J, Lee JH, Park SY, Park Y, Lee W, Song KB, Hwang DW, Kim SC. A comparison of robotic versus laparoscopic distal pancreatectomy: Propensity score matching analysis. Int J Med Robot 2021; 18:e2347. [PMID: 34726827 DOI: 10.1002/rcs.2347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to assess the perioperative and pathologic outcomes of robotic distal pancreatectomy compared with a laparoscopic approach. METHODS A total of 121 robotic distal pancreatectomies and 992 laparoscopic distal pancreatectomies were retrospectively evaluated, comparing the demographic, perioperative and pathologic outcomes. After 1:2 propensity score matching (PSM) with 11 demographic variables, the factors were analysed again. RESULTS Following PSM, 104 robotic distal pancreatectomy patients were compared with 208 laparoscopic distal pancreatectomy patients. The operation time and proportion of spleen preservation were not different between the groups. The rates of open conversion were lower, whereas the hospital costs were higher in the robotic group. Other perioperative outcomes and pathologic factors did not differ between the groups. CONCLUSIONS Although robotic distal pancreatectomy is more expensive, this operation is feasible, with a higher probability of proceeding with the planned operation and with low open conversion rate.
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Affiliation(s)
- Jaewoo Kwon
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Seo Young Park
- Department of Statistics and Data Science, Korea National Open University, Seoul, South Korea
| | - Yejong Park
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Woohyung Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Ki Byung Song
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Dae Wook Hwang
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Song Cheol Kim
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
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Giuliani G, Guerra F, De Franco L, Salvischiani L, Benigni R, Coratti A. Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer. J Pers Med 2021; 11:638. [PMID: 34357105 PMCID: PMC8306865 DOI: 10.3390/jpm11070638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to critically review the relevant evidence comparing robotic to standard laparoscopic surgery in performing radical gastrectomy. METHODS The Pubmed/Medline electronic databases were searched through February 2021. Paper conference and the English language was the only restriction applied to our search strategy. RESULTS According to the existing data, robotic gastrectomy seems to provide some benefits in terms of blood loss, rate of conversion, procedure-specific postoperative morbidity, and length of hospital stay. Robotic gastrectomy is also associated with a longer duration of surgery and a higher economic burden as compared to its laparoscopic counterpart. No significant differences have been disclosed in terms of long-term survivals, while the number of lymph nodes retrieved with robotic gastrectomy is generally higher than that of laparoscopy. CONCLUSIONS The current literature suggests that robotic radical gastrectomy appears as competent as the conventional laparoscopic procedure and may provide some clinical advantages. However, due to the relative paucity of high-level evidence, it is not possible to draw definitive conclusions.
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Affiliation(s)
- Giuseppe Giuliani
- USL Toscana Sud Est, Misericordia Hospital, 58100 Grosseto, Italy; (F.G.); (L.D.F.); (L.S.); (R.B.); (A.C.)
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