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Olakowski M, Jabłońska B, Mrowiec S. A chronicle of the pancreatoduodenectomy technique development - from the surgeon's hand to the robotic arm. Acta Chir Belg 2023; 123:94-101. [PMID: 36250406 DOI: 10.1080/00015458.2022.2135251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pancreatoduodenectomy (PD) remains one of the most challenging abdominal surgical procedures. METHODS A review of the literature regarding the history of PD, starting from the pioneers, Walter Kausch and Alan Whipple, through the great surgeons of the last century, up to the present day. RESULTS The greatest development of the PD technique took place at the end of the twentieth century. Over the last 40 years, there have been huge technological advances in medicine, which have resulted in the introduction of laparoscopic and robotic techniques for abdominal surgery. However, it turns out that PD is still performed as it used to be "by the surgeon's hand" via laparotomy rather than using the most modern robot or laparoscope and is currently recommended by experts for treatment of pancreatic head cancer (PHC). This is mainly caused by not many data comparing these three PD methods. Moreover, increasingly the results achieved by surgeons advanced in minimally invasive pancreatic resections are comparable to or even better than those achieved by the open method in reference centres. Robot-assisted PD appears to be gaining an advantage over laparoscopic technique in the efficacy of PHC treatment. The obstacles most inhibiting the use of surgical robotics are the high cost of the device and procedure, and the long learning curve. A bright future lies ahead for both methods, with the robotic technique in the forefront. CONCLUSIONS Despite significant advances in access and surgical technique, PD remains a challenging surgical procedure requiring a big surgeon's experience.
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Affiliation(s)
- Marek Olakowski
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Sławomir Mrowiec
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
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Levi Sandri GB, Abu Hilal M, Dokmak S, Edwin B, Hackert T, Keck T, Khatkov I, Besselink MG, Boggi U. Figures do matter: A literature review of 4587 robotic pancreatic resections and their implications on training. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:21-35. [PMID: 35751504 DOI: 10.1002/jhbp.1209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/07/2022] [Accepted: 06/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of robotic assistance in minimally invasive pancreatic resection is quickly growing. METHODS We present a systematic review of the literature regarding all types of robotic pancreatic resection (RPR). Our aim is to show for which procedures there is enough experience to permit safe training and provide an estimation of how many centers could serve as teaching institutions. RESULTS Sixty-four studies reporting on 4587 RPRs were analyzed. A total of 2598 pancreatoduodenectomies (PD) were reported by 28 centers from Europe (6/28; 21.4%), the Americas (11/28; 39.3%), and Asia (11/28; 39.3%). Six studies reported >100 robot PD (1694/2598; 65.2%). A total of 1618 distal pancreatectomies (DP) were reported by 29 centers from Europe (10/29; 34.5%), the Americas (10/29; 34.5%), and Asia (9/29; 31%). Five studies reported >100 robotic DP (748/1618; 46.2%). A total of 154 central pancreatectomies were reported by six centers from Europe (1/6; 16.7%), the Americas (2/6; 33.3%), and Asia (3/6; 50%). Only 49 total pancreatectomies were reported. Finally, 168 enucleations were reported in seven studies (with a mean of 15.4 cases per study). A single center reported on 60 enucleations (35.7%). Results of each type of robotic procedure are also presented. CONCLUSIONS Experience with RPR is still quite limited. Despite high case volume not being sufficient to warrant optimal training opportunities, it is certainly a key component of every successful training program and is a major criterion for fellowship accreditation. From this review, it appears that only PD and DP can currently be taught at few institutions worldwide.
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Affiliation(s)
| | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thilo Hackert
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Tobias Keck
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Igor Khatkov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ugo Boggi
- Department of Translational Research and New Surgical and Medical Technologies, Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
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Khachfe HH, Habib JR, Chahrour MA, Nassour I. Robotic pancreaticoduodenectomy: Where do we stand? Artif Intell Gastrointest Endosc 2021; 2:103-109. [DOI: 10.37126/aige.v2.i4.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreaticoduodenectomy (PD) is a complex operation accompanied by significant morbidity rates. Due to this complexity, the transition to minimally invasive PD has lagged behind other abdominal surgical operations. The safety, feasibility, favorable post-operative outcomes of robotic PD have been suggested by multiple studies. Compared to open surgery and other minimally invasive techniques such as laparoscopy, robotic PD offers satisfactory outcomes, with a non-inferior risk of adverse events. Trends of robotic PD have been on rise with centers substantially increasing the number the operation performed. Although promising, findings on robotic PD need to be corroborated in prospective trials.
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Affiliation(s)
- Hussein H Khachfe
- Surgery Department, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, United States
| | - Joseph R Habib
- Surgery Department, Johns Hopkins University, Balitmore, MD 21287, United States
| | - Mohamad A Chahrour
- Surgery Department, Henry Ford Health System, Detroit, MI 48202, United States
| | - Ibrahim Nassour
- Surgery Department, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, United States
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Khachfe HH, Habib JR, Harthi SA, Suhool A, Hallal AH, Jamali FR. Robotic pancreas surgery: an overview of history and update on technique, outcomes, and financials. J Robot Surg 2021; 16:483-494. [PMID: 34357526 DOI: 10.1007/s11701-021-01289-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The use robotics in surgery is gaining momentum. This approach holds substantial promise in pancreas surgery. Robotic surgery for pancreatic lesions and malignancies has become well accepted and is expanding to more and more center annually. The number of centers using robotics in pancreatic surgery is rapidly increasing. The most studied robotic pancreas surgeries are pancreaticoduodenectomy and distal pancreatectomy. Most studies are in their early phases, but they report that robotic pancreas surgery is safe feasible. Robotic pancreas surgery offers several advantages over open and laparoscopic techniques. Data regarding costs of robotics versus conventional techniques is still lacking. Robotic pancreas surgery is still in its early stages. It holds promise to become the new surgical standard for pancreatic resections in the future, however, more research is still needed to establish its safety, cost effectiveness and efficacy in providing the best outcomes.
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Affiliation(s)
- Hussein H Khachfe
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Division of GI Surgical Oncology, Department of Surgery, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, PA, USA.
| | - Joseph R Habib
- Division of General Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Salem Al Harthi
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Amal Suhool
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Ali H Hallal
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Faek R Jamali
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
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Xu DB, Zhao ZM, Xu Y, Liu R. Hybrid pancreatoduodenectomy in laparoscopic and robotic surgery: a single-center experience in China. Surg Endosc 2020; 35:1703-1712. [PMID: 32297052 DOI: 10.1007/s00464-020-07557-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Minimally invasive surgery is beneficial for pancreatic surgery, and the indication has been expanded to pancreatoduodenectomy (PD). The aim of this study was to share our experiences with hybrid PD in laparoscopic and robotic surgery. METHODS Sixty-four patients underwent hybrid PD in which specimen resection and gastrojejunostomy were performed through the laparoscopic route and pancreatojejunostomy and hepaticojejunostomy were performed via a robotic approach by the same surgeon at a single institution between July 2016 and June 2019. The primary endpoint was complications; secondary endpoints were operative time (OT), the length of hospital stay, and blood loss. The data for the patients were retrospectively obtained from electrical medical records. RESULTS All patients underwent surgery with the hybrid procedure. The mean OTs and estimated blood loss (EBL) were 309.7 ± 77.6 min (range 17-620 min), 160 ± 31.7 mL (range 50-800 mL). The mean number of lymph nodes retrieved was 7.3 ± 6.7 (range 0-37), and that among 45 malignant cases was 8.42 ± 6.7 (range 1-37). The average length of postoperative stay in the hospital was 11.14 ± 7.03 days (range 6-47 days). Clinically relevant postoperative pancreatic fistulas (POPFs) occurred in 39 (60.9%) cases, and most were biochemical leak POPF (29 cases, 45.3%); only 10 (15.6%) cases were grade B/C (8 cases were Grade B and 2 cases were Grade C treated with digital subtraction angiography). Bile leakage occurred in 2 (3.1%) patients. One (1.5%) patient had a gastric fistula, and 3 (4.7%) developed postoperative delayed gastric emptying categorized as International Study Group of Pancreatic Surgery (ISGPS) Grade A. Three (4.7%) patients were readmitted for postoperative bleeding, and 2 (3.1%) died within 30 days. CONCLUSION Hybrid PD with laparoscopic and robot surgery is safe and feasible. OT can be reduced by switching from the laparoscopic approach to the robotic procedure at the appropriate timepoint.
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Affiliation(s)
- Da-Bin Xu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese Medical School, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhi-Ming Zhao
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese Medical School, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yong Xu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese Medical School, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Rong Liu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese Medical School, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Liu R, Wakabayashi G, Palanivelu C, Tsung A, Yang K, Goh BKP, Chong CCN, Kang CM, Peng C, Kakiashvili E, Han HS, Kim HJ, He J, Lee JH, Takaori K, Marino MV, Wang SN, Guo T, Hackert T, Huang TS, Anusak Y, Fong Y, Nagakawa Y, Shyr YM, Wu YM, Zhao Y. International consensus statement on robotic pancreatic surgery. Hepatobiliary Surg Nutr 2019; 8:345-360. [PMID: 31489304 DOI: 10.21037/hbsn.2019.07.08] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.
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Affiliation(s)
- Rong Liu
- Department of Hepatopancreatobiliary Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Chinnusamy Palanivelu
- Division of Gastrointestinal Surgery and Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, India
| | - Allan Tsung
- Division of Surgical Oncology, Gastrointestinal Disease Specific Research Group, The Ohio State University Wexner Medical Center Department of Surgery, Columbus, OH, USA
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Charing Ching-Ning Chong
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Chang Moo Kang
- Division of HBP Surgery, Yonsei University College of Medicine, Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chenghong Peng
- Pancreatic Disease Centre, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Eli Kakiashvili
- Department of General Surgery, Galilee Medical Center, Nahariya, Israel
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu, Korea
| | - Jin He
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jae Hoon Lee
- Division of Hepatobiliary & Pancreas Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Kyoichi Takaori
- Department of Surgery, Kyoto University Hospital, Shogoin, Sakyo-Ku, Kyoto, Japan
| | - Marco Vito Marino
- Department of General Surgery, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung
| | - Tiankang Guo
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730030, China
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ting-Shuo Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung
| | - Yiengpruksawan Anusak
- Minimally Invasive Surgery Division, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA, USA
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yi-Ming Shyr
- Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, Taipei
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Zayan NE, Meara MP, Schwartz JS, Narula VK. A direct comparison of robotic and laparoscopic hernia repair: patient-reported outcomes and cost analysis. Hernia 2019; 23:1115-1121. [DOI: 10.1007/s10029-019-01943-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/27/2019] [Indexed: 01/27/2023]
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Abstract
Over the past 135 years, the field of pancreatic surgery for treatment of pancreatic malignancies has been a challenge to the surgical community. Originally filled with unacceptably high morbidity and mortality, these obstacles have been overcome through the work of numerous great surgeons in recent decades. Today, despite the improved safety of operating on the pancreas, patients still suffer from high rates of malignant recurrence and poor overall survival. Recent advances in pancreatic surgery aim to further improve the morbidity of these operations while increasing the number of patients who are both candidates for surgical resection and those who receive complete resections. This review focuses on recent literature describing the pros and cons of minimally invasive approaches to pancreatic surgery and the risks and benefits of vascular reconstruction to improve resectability. Both topics are currently debated amongst pancreatic surgeons and this article summarizes the varied viewpoints and their impact on outcomes in pancreas cancer surgery.
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Affiliation(s)
- Alexandra W Acher
- Department of General Surgery, University of Utah Health Care, Salt Lake City, UT, USA
| | - Josh Bleicher
- Department of General Surgery, University of Utah Health Care, Salt Lake City, UT, USA
| | - Austin Cannon
- Department of General Surgery, University of Utah Health Care, Salt Lake City, UT, USA
| | - Courtney Scaife
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Zhang Y, Hong D, Zhang C, Hu Z. Total laparoscopic versus robot-assisted laparoscopic pancreaticoduodenectomy. Biosci Trends 2018; 12:484-490. [PMID: 30473556 DOI: 10.5582/bst.2018.01236] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this study, the clinical effectiveness of the robot-assisted laparoscopic pancreatico-duodenectomy (RPD) and Total laparoscopic pancreaticoduodenectomy LPD were retrospectively reviewed. From December 2013 to September 2017, 20 patients underwent robot-assisted laparoscopic pancreaticoduodenectomy and 80 patients underwent Total laparoscopic pancreaticoduodenectomy. The clinical data of the RPDs and the first 20 LPDs were reviewed retrospectively. There is no difference in operative time, estimated blood loss, length of stay, and rates of complications and mortality between the LPD and RPD group. The next 10 cases in the RPD group had shorter operative times (p = 0.03) than the first 10 cases. The estimated blood loss and length of stay were also lower in the next 10 cases; however, these results did not reach statistical significance. Our results show that LPD and RPD are technically safe and feasible. Comparable results were demonstrated between the two groups, while the robotic system seemed to shorten the learning curve of minimally invasive pancreaticoduodenectomy (PD).
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Affiliation(s)
- Yuhua Zhang
- Department of Hepaticobiliarypancreatic and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's hospital of Hangzhou medical college
| | - Defei Hong
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University
| | - Chengwu Zhang
- Department of Hepaticobiliarypancreatic and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's hospital of Hangzhou medical college
| | - Zhiming Hu
- Department of Hepaticobiliarypancreatic and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's hospital of Hangzhou medical college
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Watkins AA, Kent TS, Gooding WE, Boggi U, Chalikonda S, Kendrick ML, Walsh RM, Zeh HJ, Moser AJ. Multicenter outcomes of robotic reconstruction during the early learning curve for minimally-invasive pancreaticoduodenectomy. HPB (Oxford) 2018; 20:155-165. [PMID: 28966031 DOI: 10.1016/j.hpb.2017.08.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/15/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perceived excess morbidity during the early learning curve of minimally-invasive pancreaticoduodenectomy (MIPD) has limited widespread adoption. It was hypothesized that robot-assisted reconstruction (RA) after MIPD allows anastomotic outcomes equivalent to open pancreaticoduodenectomy (PD). METHODS Intent to treat analysis of centrally audited data accrued during early adoption of RA-MIPD at five centers. RESULTS CUSUM analysis of operating times at each center identified 92 RA-MIPD during the early learning curve. Mean age was 65 ± 12 years with body mass index 25.8 ± 5.0. Surgical indications included malignant (60%) and premalignant (38%) lesions. Median operating time was 504 min (interquartile range 133) with 242 ml median estimated blood loss (IQR 398) and twelve (13%) conversions to open PD. Major complication rate (Clavien-Dindo III/IV) was 24% with 2 (2.2%) deaths and ten (10.9%) reoperations. Nine (9.9%) clinically significant pancreatic fistulae were observed (4 grade B; 5 grade C). Margin negative resection rate for malignancy was 90% (75% for PDA) with mean harvest of 16 ± 8 lymph nodes. CONCLUSIONS These multicenter data during the early learning curve for RA-MIPD do not demonstrate excess anastomotic morbidity compared to open. Further studies are required to determine whether surgeon proficiency and evolving technique improve anastomotic outcomes compared to open.
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Affiliation(s)
- Ammara A Watkins
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tara S Kent
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William E Gooding
- The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, PA, USA
| | | | - Sri Chalikonda
- Departments of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - R Matthew Walsh
- Departments of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Herbert J Zeh
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - A James Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Kim HS, Han Y, Kang JS, Kim H, Kim JR, Kwon W, Kim SW, Jang JY. Comparison of surgical outcomes between open and robot-assisted minimally invasive pancreaticoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 25:142-149. [PMID: 29117639 DOI: 10.1002/jhbp.522] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Robot surgery is a new method that maintains advantages and overcomes disadvantages of conventional methods, even in pancreatic surgery. This study aimed to evaluate safety and benefits of robot-assisted minimally invasive pancreaticoduodenectomy (robot PD). METHODS This study included 237 patients who underwent PD between 2015 and 2017. Demographics and surgical outcomes were evaluated. RESULTS Fifty-one patients underwent robot PD and 186 underwent open PD. Robot PD group had younger age (60.7 vs. 65.4 years, P = 0.006) and lower body mass index (22.7 vs. 24.0, P = 0.007). Robot PD group had lower proportion of patients with firm or hard pancreatic texture (15.7% vs. 38.2%, P = 0.004) and smaller pancreatic duct size (2.3 vs. 3.3 mm, P = 0.002). Two groups had similar operation time (robot vs. open: 335.6 vs. 330.1 min) and complications (15.7% vs. 21.0%), including postoperative pancreatic fistula rate (6.0% vs. 12.0%). Robot PD group had lower postoperative pain score (3.7 vs. 4.1 points, P = 0.008), and shorter postoperative stay (10.6 vs. 15.3 days, P = 0.001). CONCLUSION Robot PD is comparable to open PD in early outcomes. Robot PD is safe and feasible and enables early recovery; indication for robot PD is expected to expand in the near future.
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Affiliation(s)
- Hyeong Seok Kim
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
| | - Youngmin Han
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
| | - Jae Seung Kang
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
| | - Hongbeom Kim
- Department of Surgery, Dongguk University College of Medicine, Ilsan, Korea
| | - Jae Ri Kim
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea
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Li Y, Wu W, Zhang T, Liao Q, Zhao Y, Dai M. Comparison of long-term benefits of organ-preserving pancreatectomy techniques for benign or low-grade malignant tumors at the pancreatic head. Medicine (Baltimore) 2017; 96:e9420. [PMID: 29390567 PMCID: PMC5758269 DOI: 10.1097/md.0000000000009420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this article was to investigate and emphasize the clinical benefits of organ-preserving surgeries by comparing the pancreatic head resection with segmental duodenectomy (PHRSD), pylorus-preserving pancreatoduodenectomy (PPPD), and classic pancreatoduodenectomy (PD).A retrospective analysis of PHRSD (20 patients), PPPD (42 patients), and PD (92 patients) with benign lesions, low-grade malignancies, or early-stage carcinomas at the pancreatic head was performed since 2008. The intraoperative and postoperative courses and a long-term statuses were compared.The overall average age of the patients in 3 groups was 48.82 years old (range 12-76). The mean operative time and the blood loss were significantly less in the PHRSD and PPPD groups than that in the PD group (P < .05), but there were no differences between the PHRSD and PPPD groups. The possibilities of postoperative complications were equivalent in all 3 groups. During an average follow-up time of 61.1 months, there were no recurrence or distant metastasis happened. Patients in the PHRSD and PPPD groups had a better long-term nutritional status because they had less body weight loss (P < .01), and suffered less from long-term diarrhea (P < .001) than that in the PD group. However, the results in the PPPD group seemed to be better than that in the PHRSD group.PHRSD and PPPD are ideal procedures of organ-preserving pancreatectomy to fulfill the curative goals of benign lesions, low-grade malignancies, or early-stage carcinomas at the pancreatic head. It was proved to be operative safe and could bring patients with a better nutritional status and quality of life after surgery. However, PHRSD was more difficult with no better long-term benefits than PPPD, which asked a comprehensive consideration when made the surgical choice.
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Chen K, Pan Y, Liu XL, Jiang GY, Wu D, Maher H, Cai XJ. Minimally invasive pancreaticoduodenectomy for periampullary disease: a comprehensive review of literature and meta-analysis of outcomes compared with open surgery. BMC Gastroenterol 2017; 17:120. [PMID: 29169337 PMCID: PMC5701376 DOI: 10.1186/s12876-017-0691-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/17/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Minimally invasive pancreatoduodenectomy (MIPD) has been gradually attempted. However, whether MIPD is superior, equal or inferior to its conventional open pancreatoduodenectomy (OPD) is not clear. METHODS Studies published up to May 2017 were searched in PubMed, Embase, Cochrane Library, and Web of Science. Main outcomes were comprehensively reviewed and measured including conversion to open approach, operation time (OP), estimated blood loss (EBL), transfusion, length of hospital stay (LOS), overall complications, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), readmission, reoperation and reasons of preoperative death, number of retrieved lymph nodes (RLN), surgical margins, recurrence, and survival. The software of Review Manage version 5.1 was used for meta-analysis. RESULTS One hundred studies were included for systematic review and 26 out of them (totally 3402 cases, 1064 for MIPD, 2338 for OPD) were included for meta-analysis. In the early years, most articles were case reports or non-control case series studies, while in the last 6 years high-volume and comparative researches were increasing gradually. Systematic review revealed conversion rates of MIPD to OPD ranged from 0% to 40%. The mean or median OP of MIPD ranged from 276 to 657 min. The total POPF rates vary between 3.8% and 50% observed in all systematic reviewed studies. Meta-analysis demonstrated MIPD had longer OP (WMD = 99.4 min; 95%CI: 46.0 ~ 152.8, P < 0.01), lower blood loss (WMD = -0.54 ml; 95% CI, -0.88 ~ -0.20 ml; P < 0.01), lower transfusion rate (RR = 0.73, 95%CI: 0.57 ~ 0.94, P = 0.02), shorter LOS (WMD = -3.49 days; 95%CI: -4.83 ~ -2.15, P < 0.01). There was no significant difference in time to oral intake, postoperative complications, POPF, reoperation, readmission, perioperative mortality and number of retrieved lymph nodes. CONCLUSION Our study demonstrates MIPD is technically feasible and safety on the basis of historical studies. MIPD is associated with less blood loss, faster postoperative recovery, shorter length of hospitalization and longer operation time. These findings are waiting for being confirmed with robust prospective comparative studies and randomized clinical trials.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Xiao-Long Liu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Guang-Yi Jiang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Di Wu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Hendi Maher
- School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Xiu-Jun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China.
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Galvez D, Sorber R, Javed AA, He J. Technical considerations for the fully robotic pancreaticoduodenectomy. J Vis Surg 2017; 3:81. [PMID: 29078644 DOI: 10.21037/jovs.2017.05.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/04/2017] [Indexed: 12/30/2022]
Abstract
Minimally invasive surgery, including robotic surgery, has become the standard of care for many abdominal procedures. However, the technical complexity associated with pancreaticoduodenectomy (PD) due to the anatomic location and oncologic characteristics of pancreatic tumors has hindered the widespread application of minimally invasive techniques to this procedure. Recent studies have reported that for experienced surgeons, the application of robotic techniques to PD is associated with equivalent oncologic outcomes and rates of complication when compared to an open operation, and may be associated with accelerated surgical recovery. Despite these encouraging results, robotic PD (RPD) is a procedure attempted by a small group of pancreatic surgeons, leading to the great heterogeneity in the techniques used to perform this operation. Herein we describe our technique for fully RPD and demonstrate its execution with a video supplement.
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Affiliation(s)
- Daniel Galvez
- Department of Surgery, The Johns Hopkins Hospital Baltimore, MD 21215, USA
| | - Rebecca Sorber
- Department of Surgery, The Johns Hopkins Hospital Baltimore, MD 21215, USA
| | - Ammar A Javed
- Department of Surgery, The Johns Hopkins Hospital Baltimore, MD 21215, USA
| | - Jin He
- Department of Surgery, The Johns Hopkins Hospital Baltimore, MD 21215, USA
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15
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Lianos GD, Christodoulou DK, Katsanos KH, Katsios C, Glantzounis GK. Minimally Invasive Surgical Approaches for Pancreatic Adenocarcinoma: Recent Trends. J Gastrointest Cancer 2017; 48:129-134. [PMID: 28326457 DOI: 10.1007/s12029-017-9934-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic resection for cancer represents a real challenge for every surgeon. Recent improvements in laparoscopic experience, minimally invasive surgical techniques and instruments make now the minimally invasive approach a real "triumph." There is no doubt that minimally invasive surgery has replaced with great success conventional surgery in many fields, including surgical oncology. METHODS AND RESULTS However, its progress in pancreatic resection for adenocarcinoma has been dramatically slow. Recent evidence supports the notion that minimally invasive distal pancreatectomy is safe and feasible and that is becoming the procedure of choice mainly for benign or low-grade malignant lesions in the distal pancreas. On the other side, minimally invasive pancreatoduodenectomy has not yet been widely accepted and there is enormous skepticism when applied for pancreatic head adenocarcinoma. In this review, we summarize the current evidence on the potential applications of minimally invasive surgical approaches for this aggressive, heterogeneous, and enigmatic type of cancer. CONCLUSIONS Moreover, the potential future applications of these approaches are discussed with the hope to improve the quality of life as well as the survival rates of pancreatic cancer patients.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece.
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Christos Katsios
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
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16
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Montagnini AL, Røsok BI, Asbun HJ, Barkun J, Besselink MG, Boggi U, Conlon KCP, Fingerhut A, Han HS, Hansen PD, Hogg ME, Kendrick ML, Palanivelu C, Shrikhande SV, Wakabayashi G, Zeh H, Vollmer CM, Kooby DA. Standardizing terminology for minimally invasive pancreatic resection. HPB (Oxford) 2017; 19:182-189. [PMID: 28317657 DOI: 10.1016/j.hpb.2017.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a growing body of literature pertaining to minimally invasive pancreatic resection (MIPR). Heterogeneity in MIPR terminology, leads to confusion and inconsistency. The Organizing Committee of the State of the Art Conference on MIPR collaborated to standardize MIPR terminology. METHODS After formal literature review for "minimally invasive pancreatic surgery" term, key terminology elements were identified. A questionnaire was created assessing the type of resection, the approach, completion, and conversion. Delphi process was used to identify the level of agreement among the experts. RESULTS A systematic terminology template was developed based on combining the approach and resection taking into account the completion. For a solitary approach the term should combine "approach + resection" (e.g. "laparoscopic pancreatoduodenectomy); for combined approaches the term must combine "first approach + resection" with "second approach + reconstruction" (e.g. "laparoscopic central pancreatectomy" with "open pancreaticojejunostomy") and where conversion has resulted the recommended term is "first approach" + "converted to" + "second approach" + "resection" (e.g. "robot-assisted" "converted to open" "pancreatoduodenectomy") CONCLUSIONS: The guidelines presented are geared towards standardizing terminology for MIPR, establishing a basis for comparative analyses and registries and allow incorporating future surgical and technological advances in MIPR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul D Hansen
- Portland Providence Cancer Center, Portland, OR, USA
| | - Melissa E Hogg
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | - Herbert Zeh
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - David A Kooby
- Emory University School of Medicine, Atlanta, GA, USA
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17
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Frosini F, Miniati R, Grillone S, Dori F, Gentili GB, Belardinelli A. Integrated HTA-FMEA/FMECA methodology for the evaluation of robotic system in urology and general surgery. Technol Health Care 2016; 24:873-887. [DOI: 10.3233/thc-161236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francesco Frosini
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Roberto Miniati
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Saverio Grillone
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Fabrizio Dori
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Guido Biffi Gentili
- Department of Information Engineering, School of Engineering, University of Florence, Florence, Italy
| | - Andrea Belardinelli
- Innovation and Planning Area, Head Management, Florence Teaching Hospital AOU-Careggi, Florence, Italy
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18
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Wang M, Cai Y, Li Y, Peng B. Robotic Pancreaticoduodenectomy: Single-Surgeon Initial Experience. Indian J Surg 2016; 80:42-47. [PMID: 29581684 DOI: 10.1007/s12262-016-1555-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/07/2016] [Indexed: 02/05/2023] Open
Abstract
Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and effective procedure in an experienced surgeon's hands, but the adaptations to the clumsy instruments are needed. The improved dexterity of the Da Vinci robotic system provides a good opportunity to perform this challenging procedure in the minimally invasive context. The aim of this study was to share our preliminary experience of totally robotic pancreaticoduodenectomy. From April 2015 to August 2015, four patients were selected to undergo totally robotic pancreaticoduodenectomy in the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. The demographic characteristics, perioperative details, and pathological results were retrospectively reviewed. One female and two male patients underwent totally robotic pancreaticoduodenectomy, while another male patient underwent robotic total pancreatectomy due to the severe atrophy of pancreatic body and tail. The mean age of the four patients was 56.8 years. The average operation time and intraoperative blood loss were 563 min and 228 mL, respectively. No one needed blood transfusion, conversion to open pancreaticoduodenectomy, or postoperative analgesia. The postoperative courses of these patients were uneventful. The mean postoperative hospital stay was 10 days. No one required to be readmitted, and there was no death within 30 days following the surgery. Final pathologic examinations revealed one malignant pancreatic ductal adenocarcinoma, and three benign lesions. Based on this initial study, robotic pancreaticoduodenectomy is safe and feasible, with acceptable oncological outcomes for highly selected patients in experienced surgeons' hands. However, concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure.
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Affiliation(s)
- Mingjun Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
| | - Yunqiang Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
| | - Yongbin Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
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19
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Revisiting robotic approaches to endocrine neoplasia: do the data support their continued use? Curr Opin Oncol 2016; 28:26-36. [PMID: 26632768 DOI: 10.1097/cco.0000000000000245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Although the advent of the robot has revolutionized the modern treatment of endocrine neoplasia, substantial controversies exist on its applicability, safety and benefits over the conventional laparoscopic operations. The present review aims to review the recent literature on various robotic approaches in treating thyroid, parathyroid, adrenal and pancreatic endocrine neoplasia and see whether its continued use should be supported. RECENT FINDINGS In summary, the role of robotic thyroidectomy has been clearly established and should be continued by experienced surgeons on selected patients. Because of the limited availability of evidence, the feasibility of robotic parathyroidectomy has yet to be elucidated. With proven favorable perioperative outcomes, robotic adrenalectomy and pancreatectomy should be continued as potential alternatives to conventional surgery. SUMMARY Robotic endocrine procedures still play a pivotal role in minimally invasive endocrine surgery with demonstrable safety and effectiveness. Future research should embark on prospective randomized-controlled trials on robotic endocrine procedures to collect higher level of evidence and long-term survival data.
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20
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Zhang YH, Zhang CW, Hu ZM, Hong DF. Pancreatic cancer: Open or minimally invasive surgery? World J Gastroenterol 2016; 22:7301-7310. [PMID: 27621576 PMCID: PMC4997638 DOI: 10.3748/wjg.v22.i32.7301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/04/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.
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21
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Ramera M, Damoli I, Giardino A, Bassi C, Butturini G. Robotic pancreatectomies. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2016; 3:29-36. [PMID: 30697553 PMCID: PMC6193431 DOI: 10.2147/rsrr.s81560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pancreatic surgery represents one of the most challenging fields in general surgery. Its complexity is related to the severity of the disease and the technical skills required for surgical approach. Given this, most pancreatic resections are performed through classic open surgery. Minimally invasive approaches are gradually gaining widespread popularity also in this specific setting, as for distal resections and enucleations. The robotic platform, due to its 3-dimensional vision and articulated movements, represents the natural progress of laparoscopic surgery overcoming the technical defaults and opening up the possibility to perform major pancreatic resections as pancreaticoduodenectomies. This review focuses on the impact of robotic platform in pancreatic surgery in terms of surgical and oncological outcome.
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Affiliation(s)
- Marco Ramera
- General Surgery Unit B, The Pancreas Institute, Verona University Hospital Trust
| | - Isacco Damoli
- General Surgery Unit B, The Pancreas Institute, Verona University Hospital Trust
| | - Alessandro Giardino
- Hepato-Pancreato-Biliary Unit, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy,
| | - Claudio Bassi
- General Surgery Unit B, The Pancreas Institute, Verona University Hospital Trust
| | - Giovanni Butturini
- Hepato-Pancreato-Biliary Unit, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy,
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Napoli N, Kauffmann EF, Palmeri M, Miccoli M, Costa F, Vistoli F, Amorese G, Boggi U. The Learning Curve in Robotic Pancreaticoduodenectomy. Dig Surg 2016; 33:299-307. [PMID: 27215422 DOI: 10.1159/000445015] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE Few data are available on the learning curve (LC) in robot-assisted pancreaticoduodenectomy (RAPD) and no study specifically addresses the LC of a single surgeon. METHODS The LC of a single surgeon in RAPD was determined using the cumulative sum method, based on operative time (OT). Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of index operation. RESULTS Seventy RAPD were analyzed. One operation was converted to open surgery (1.4%). One patient died within 30 days (1.4%) and one within 90 days (2.8%). Postoperative complications occurred in 53 patients (75.7%) and exceeded Clavien-Dindo grade IIIb in 7 patients (10%). OT dropped after 33 operations from a mean of 564 ± 101.7 min to a mean of 484.1 ± 77.9 min (p = 0.0005) and was associated to reduced incidence of delayed gastric emptying (72.7 vs. 48.7%; p = 0.039). The rate of hospital readmission improved after 40 operations from 20.0 (8 of 40) to 3.3% (1 of 30) (p = 0.04). CONCLUSIONS RAPD was safely feasible in selected patients. OT dropped after the first 33 operations and was associated with reduced rate of delayed gastric emptying. Readmission rate improved after 40 operations.
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Affiliation(s)
- N Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
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23
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Fernandes E, Giulianotti PC. Robotic-assisted pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 20:583-9. [PMID: 23588851 DOI: 10.1007/s00534-013-0615-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. METHODS As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. RESULTS Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. CONCLUSION Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short- and long-term outcomes seem to be similar to the ones achieved in open surgery.
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Affiliation(s)
- E Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA.
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24
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Piedimonte S, Wang Y, Bergman S, Vanounou T. Early experience with robotic pancreatic surgery in a Canadian institution. Can J Surg 2016; 58:394-401. [PMID: 26574831 DOI: 10.1503/cjs.003815] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pancreatic resections have traditionally been associated with substantial morbidity and mortality. The robotic platform is believed to improve technical aspects of the procedure while offering minimally invasive benefits. We sought to determine the safety and feasibility of the first robotic pancreaticoduodenectomies performed at our institution. METHODS We retrospectively reviewed data on all patients who underwent robotic-assisted pancreaticoduodenectomy (RAPD) between July 2010 and June 2014 and compared them to outcomes of patients undergoing hybrid laparoscopic pancreaticoduodenectomies (HLAPD) during the same time period. RESULTS Fifteen patients were scheduled for RAPD; 2 were converted to an open approach and 1 to a mini-laparotomy during the laparoscopic portion of the procedure. Patients who had RAPD (n = 12) had a median duration of surgery of 596.6 (range 509-799) minutes, estimated blood loss of 275 (range 50-1000) mL and median length of stay of 7.5 (range 5-57) days. Mean total opioid use up to postoperative day 7 was 142.599 ± 68.2 versus 176.9 ± 112.7 mg equivalents of intravenous morphine for RAPD and HLAPD, respectively. There was no significant difference between RAPD and HLAPD in any parameters, highlighting the safety and feasibility of a step-wise minimally invasive learning platform. Most patients in the RAPD group had malignant pathology (88.2%). Oncologic outcomes were maintained with no significant difference in ability to resect lymph nodes or achieve negative margins. There were 4 (28.5%) Clavien I-II complications and 3 (29.4%) Clavien III- IV complications, 2 of which required readmission. There were no reported deaths at 90 days. Complication, pancreatic leak and mortality rates did not differ significantly from our laparoscopic experience. CONCLUSION Outcomes of RAPD and HLAPD were comparable at our centre, even during the early stages of our learning curve. These results also highlight the safety, feasibility and patient benefits of a step-wise transition from open to hybrid to fully robotic pancreaticoduodenectomies in a high-volume academic centre.
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Affiliation(s)
- Sabrina Piedimonte
- From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman)
| | - Yifan Wang
- From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman)
| | - Simon Bergman
- From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman)
| | - Tsafrir Vanounou
- From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman)
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Zhan Q, Deng X, Weng Y, Jin J, Wu Z, Li H, Shen B, Peng C. Outcomes of robotic surgery for pancreatic ductal adenocarcinoma. Chin J Cancer Res 2016; 27:604-10. [PMID: 26752935 DOI: 10.3978/j.issn.1000-9604.2015.05.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To explore the effectiveness, safety, and efficacy of the robot-assisted surgery in the radical resection of pancreatic ductal adenocarcinoma (PDAC). METHODS The clinical data of 72 patients with PDAC who underwent radical resection using the da Vinci Surgical System from April 2010 to December 2014 were retrospectively analyzed. RESULTS Among these 72 patients, three were converted to conventional laparotomy due to the vascular invasion or due to the difficulties in tissue isolation from the surrounding organs. Among 39 patients who underwent the pancreatoduodenectomy, the average operative time was 395.3±118.8 min, and the mean intra-operative blood loss was 447.3±269.9 mL. Among 31 patients who underwent the distal pancreatectomy (DP), the average operative time was 185.5±74.1 min, and the mean intra-operative blood loss was 267.1±305.3 mL. In two patients who received the middle pancreatectomy (MP), the average operative time was 225 min and mean intra-operative blood loss was 100 mL. Among all the 72 patients, an average of 4.2±2.6 lymph nodes were dissected, with an average hospital stay of 22.6±10.7 days. Complications were observed in 18 patients, which included pancreatic fistula (n=11), bile leak (n=5), anastomotic bleeding (n=2), pancreatic fistula complicated with portal vein thrombosis (n=1), and anastomotic bleeding complicated with acute renal failure (n=1). Except that one patient died due to post-operative bleeding and acute renal failure, all the other patients were cured after conservative treatment. These 72 patients were followed for 1-45 (15.6±5.8) months, during which 10 patients died. Eleven patients suffered from recurrence or metastasis, among which 6 had local recurrence, 4 had liver metastasis, and 1 had ascites accompnaied with incision site tumor metastasis. CONCLUSIONS Radical resection of PDAC by robotic surgical system is safe and feasible. It has less surgical trauma and enables faster post-operative recovery, and therefore can achieve the lymph node dissection scope and tumor resection margin required by the standards of radical resection for pancreatic cancer. Nevertheless, its long-term efficacy requires further validation.
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Affiliation(s)
- Qian Zhan
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Xiaxing Deng
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Yuanchi Weng
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Jiabin Jin
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Zhichong Wu
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Hongwei Li
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Baiyong Shen
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Chenghong Peng
- 1 Department of General Surgery, Ruijin Hospital, Shanghai 200025, China ; 2 Research Institute of Pancreatic Diseases, School of medicine, Shanghai Jiaotong University, Shanghai 200240, China
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Baker EH, Ross SW, Seshadri R, Swan RZ, Iannitti DA, Vrochides D, Martinie JB. Robotic pancreaticoduodenectomy for pancreatic adenocarcinoma: role in 2014 and beyond. J Gastrointest Oncol 2015; 6:396-405. [PMID: 26261726 DOI: 10.3978/j.issn.2078-6891.2015.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/09/2015] [Indexed: 12/26/2022] Open
Abstract
Minimally invasive surgery (MIS) for pancreatic adenocarcinoma has found new avenues for performing pancreaticoduodenectomy (PD) procedures, a historically technically challenging operation. Multiple studies have found laparoscopic PD to be safe, with equivalent oncologic outcomes as compared to open PD. In addition, several series have described potential benefits to minimally invasive PD including fewer postoperative complications, shorter hospital length of stay, and decreased postoperative pain. Yet, despite these promising initial results, laparoscopic PDs have not become widely adopted by the surgical community. In fact, the vast majority of pancreatic resections performed in the United States are still performed in an open fashion, and there are only a handful of surgeons who actually perform purely laparoscopic PDs. On the other hand, robotic assisted surgery offers many technical advantages over laparoscopic surgery including high-definition, 3-D optics, enhanced suturing ability, and more degrees of freedom of movement by means of fully-wristed instruments. Similar to laparoscopic PD, there are now several case series that have demonstrated the feasibility and safety of robotic PD with seemingly equivalent short-term oncologic outcomes as compared to open technique. In addition, having the surgeon seated for the procedure with padded arm-rests, there is an ergonomic advantage of robotics over both open and laparoscopic approaches, where one has to stand up for prolonged periods of time. Future technologic innovations will likely focus on enhanced robotic capabilities to improve ease of use in the operating room. Last but not least, robotic assisted surgery training will continue to be a part of surgical education curriculum ensuring the increased use of this technology by future generations of surgeons.
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Affiliation(s)
- Erin H Baker
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Samuel W Ross
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Ramanathan Seshadri
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Ryan Z Swan
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - David A Iannitti
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - Dionisios Vrochides
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
| | - John B Martinie
- Division of Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
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Stafford AT, Walsh RM. Robotic surgery of the pancreas: The current state of the art. J Surg Oncol 2015. [PMID: 26220683 DOI: 10.1002/jso.23952] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pancreatic surgery is one of the most technically challenging and complex types of surgery. Most pancreatic surgery is performed with the open technique, yet minimally invasive surgery has become the standard of care for many other intra-abdominal operations. The unique qualities of the robotic platform have made this approach to pancreatic surgery safe and feasible with at least equivalent if not better results than the open platform in terms of surgical and oncological outcomes.
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Affiliation(s)
- Anthony T Stafford
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - R Matthew Walsh
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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Minimally invasive pancreatic surgery - a review. Wideochir Inne Tech Maloinwazyjne 2015; 10:141-9. [PMID: 26240612 PMCID: PMC4520856 DOI: 10.5114/wiitm.2015.52705] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/12/2015] [Accepted: 06/14/2015] [Indexed: 01/01/2023] Open
Abstract
During the past 20 years the application of a minimally invasive approach to pancreatic surgery has progressively increased. Distal pancreatectomy is the most frequently performed procedure, because of the absence of a reconstructive phase. However, middle pancreatectomy and pancreatoduodenectomy have been demonstrated to be safe and feasible as well. Laparoscopic distal pancreatectomy is recognized as the gold standard treatment for small tumors of the pancreatic body-tail, with several advantages over the traditional open approach in terms of patient recovery. The surgical treatment of lesions of the pancreatic head via a minimally invasive approach is still limited to a few highly experienced surgeons, due to the very challenging resection and complex anastomoses. Middle pancreatectomy and enucleation are indicated for small and benign tumors and offer the maximum preservation of the parenchyma. The introduction of a robotic platform more than ten years ago increased the interest of many surgeons in minimally invasive treatment of pancreatic diseases. This new technology overcomes all the limitations of laparoscopic surgery, but actual benefits for the patients are still under investigation. The increased costs associated with robotic surgery are under debate too. This article presents the state of the art of minimally invasive pancreatic surgery.
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Parisi A, Desiderio J, Trastulli S, Cirocchi R, Renzi C, Boselli C, De Santis F, Petrina A, Annecchiarico M, Di Marino M, Bencini L, Perna F, Pironi D, Santoro A, Coratti A. Robotic pylorus-preserving pancreaticoduodenectomy: Technical considerations. Int J Surg 2015; 21 Suppl 1:S59-63. [PMID: 26118615 DOI: 10.1016/j.ijsu.2015.06.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/24/2015] [Accepted: 04/10/2015] [Indexed: 01/29/2023]
Abstract
Laparoscopy has revolutionized the way of thinking abdominal surgery, however, to date there are still limitations making it difficult to apply this technique to some types of surgical procedures considered technically demanding even when performed by open surgery, such as the pancreaticoduodenectomy. This technical note provides a complete description of the surgical procedure performed for the execution of a robotic pancreaticoduodenectomy through the use of the "Da Vinci Si" robotic system. Robotic systems represent a real evolution in minimally invasive surgery. We wish to emphasize this concept, highlighting the application of this technology to complex procedures in digestive surgery.
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Affiliation(s)
- Amilcare Parisi
- Department of Digestive Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
| | - Jacopo Desiderio
- Department of Digestive Surgery and Liver Unit, St. Maria Hospital, Terni, Italy.
| | - Stefano Trastulli
- Department of Digestive Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, St. Maria Hospital, Terni, Italy
| | - Caudio Renzi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Francesco De Santis
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Adolfo Petrina
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Michele Di Marino
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Lapo Bencini
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Federico Perna
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
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Milone L, Daskalaki D, Wang X, Giulianotti PC. State of the art of robotic pancreatic surgery. World J Surg 2015; 37:2761-70. [PMID: 24129799 DOI: 10.1007/s00268-013-2275-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
More than a decade has passed since robotic technology was adopted for abdominal surgery, and virtually every gastrointestinal operation has since been shown to be feasible, safe, and reproducible using the robotic approach. Robotic pancreatic surgery had been left behind at the beginning, because they were technically challenging, requiring not only being very familiar with the robotic technology but also having a perfect knowledge of the anatomical variations, very frequent in this area. Nonetheless in the last few years many authors have approached the robot for pancreatic surgery with very promising results in terms of surgical and oncological outcomes. The aim of this article is to review the literature on robotic pancreatic surgery and to define the state of the art use of the robotic approach for pancreatic disease.
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Affiliation(s)
- Luca Milone
- Division of Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood MC 958 Room 435 E, Chicago, IL, 60612, USA
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Kriger AG, Berelavichus SV, Gorin DS, Kaldarov AR, Karel'skaya NA, Akhtanin EA. [Robot-assisted pancreatoduodenectomy]. Khirurgiia (Mosk) 2015:50-56. [PMID: 26762078 DOI: 10.17116/hirurgia2015950-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To compare the results of robot-assisted and conventional techniques of pancreatoduodenectomy. MATERIAL AND METHODS It was performed the retrospective investigation of results of robot-assisted and conventional pylorus-preserving pancreatoduodenectomy in 7 and 7 patients respectively. RESULTS Duration of robot-assisted and conventional surgery was 460.71±119.77 and 288.57±62.2 minutes, volume of blood loss--414.28±285.36 and 400±163.30 ml respectively. Postoperative complications after robot-assisted technique were classified as Grade I according to Clavien-Dindo classification. Pancreatic fistulae were absent (ISGPF (2005)). Lower duration of abdominal drainage and opioid analgesia were observed. Also narcotic drugs were required by not all patients after robot-assisted surgery. Histological study revealed the large number of excised lymphatic nodes. CONCLUSION Obvious advantage of robot-assisted operation was precision of great vessels and lymphatic nodes dissection, performing anastomoses. Robot-assisted pancreatoduodenectomy corresponds to all requirements inherent to radical cancer surgery.
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Affiliation(s)
- A G Kriger
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - S V Berelavichus
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - D S Gorin
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - A R Kaldarov
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - N A Karel'skaya
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - E A Akhtanin
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
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Kang CM, Lee SH, Chung MJ, Hwang HK, Lee WJ. Laparoscopic pancreatic reconstruction technique following laparoscopic pancreaticoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:202-10. [PMID: 25546026 DOI: 10.1002/jhbp.193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the advance of laparoscopic experiences and techniques, it is carefully regarded that laparoscopic pancreaticoduodenectomy (lap-PD) is feasible and safe in managing perimapullary pancreatic pathology. Especially, laparoscopic management of remnant pancreas can be a critical step toward completeness of minimally invasive PD. According to available published reports, there is a wide range of technical differences in choosing surgical options in managing remnant pancreas after lap-PD. For the evidence-based surgical approach, it would be ideal to test potential techniques by randomized controlled trials, but, currently, it is thought to be very difficult to expect those clinical trials to be successful because there are still a lack of expert surgeons with sound surgical techniques and experience. In addition, lap-PD is so complicated and technically demanding that many surgeons are still questioning whether this surgical approach could be standardized and popular like laparoscopic cholecystectomy. In general, surgical options are usually chosen based on following question: (1) Is it simple? (2) Is it easy and feasible? (3) Is it secure and safe? (4) Is there any supporting scientific evidence? It would be interesting to estimate which surgical technique would be appropriate in managing remnant pancreas under these considerations. It is hoped that a well standardized multicenter-based randomized control study would be successful to test this fundamental issues based on sound surgical techniques and scientific background.
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Affiliation(s)
- Chang Moo Kang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #203, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea; Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Institute of Gastroenterology, Severance Hospital, Seoul, Korea
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Parisi A, Desiderio J, Trastulli S, Grassi V, Ricci F, Farinacci F, Cacurri A, Castellani E, Corsi A, Renzi C, Barberini F, D'Andrea V, Santoro A, Cirocchi R. Robotic pancreaticoduodenectomy in a case of duodenal gastrointestinal stromal tumor. World J Surg Oncol 2014; 12:372. [PMID: 25475024 PMCID: PMC4289318 DOI: 10.1186/1477-7819-12-372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022] Open
Abstract
Background Laparoscopic pancreaticoduodenectomy is rarely performed, and it has not been particularly successful due to its technical complexity. The objective of this study is to highlight how robotic surgery could improve a minimally invasive approach and to expose the usefulness of robotic surgery even in complex surgical procedures. Case presentation The surgical technique employed in our center to perform a pancreaticoduodenectomy, which was by means of the da Vinci™ robotic system in order to remove a duodenal gastrointestinal stromal tumor, is reported. Conclusions Robotic technology has improved significantly over the traditional laparoscopic approach, representing an evolution of minimally invasive techniques, allowing procedures to be safely performed that are still considered to be scarcely feasible or reproducible.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Claudio Renzi
- Department of General and Oncologic Surgery, University of Perugia, Piazzale Gambuli 1, Perugia, 06157, Italy.
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Joyce D, Morris-Stiff G, Falk GA, El-Hayek K, Chalikonda S, Walsh RM. Robotic surgery of the pancreas. World J Gastroenterol 2014; 20:14726-14732. [PMID: 25356035 PMCID: PMC4209538 DOI: 10.3748/wjg.v20.i40.14726] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/11/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Pancreatic surgery is one of the most challenging and complex fields in general surgery. While minimally invasive surgery has become the standard of care for many intra-abdominal pathologies the overwhelming majority of pancreatic surgery is performed in an open fashion. This is attributed to the retroperitoneal location of the pancreas, its intimate relationship to major vasculature and the complexity of reconstruction in the case of pancreatoduodenectomy. Herein, we describe the application of robotic technology to minimally invasive pancreatic surgery. The unique capabilities of the robotic platform have made the minimally invasive approach feasible and safe with equivalent if not better outcomes (e.g., decreased length of stay, less surgical site infections) to conventional open surgery. However, it is unclear whether the robotic approach is truly superior to traditional laparoscopy; this is a key point given the substantial costs associated with procuring and maintaining robotic capabilities.
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35
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Anderson B, Karmali S. Laparoscopic resection of pancreatic adenocarcinoma: Dream or reality? World J Gastroenterol 2014; 20:14255-14262. [PMID: 25339812 PMCID: PMC4202354 DOI: 10.3748/wjg.v20.i39.14255] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/27/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic pancreatic surgery is in its infancy despite initial procedures reported two decades ago. Both laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreaticoduodenectomy (LPD) can be performed competently; however when minimally invasive surgical (MIS) approaches are implemented the indication is often benign or low-grade malignant pathologies. Nonetheless, LDP and LPD afford improved perioperative outcomes, similar to those observed when MIS is utilized for other purposes. This includes decreased blood loss, shorter length of hospital stay, reduced post-operative pain, and expedited time to functional recovery. What then is its role for resection of pancreatic adenocarcinoma? The biology of this aggressive cancer and the inherent challenge of pancreatic surgery have slowed MIS progress in this field. In general, the overall quality of evidence is low with a lack of randomized control trials, a preponderance of uncontrolled series, short follow-up intervals, and small sample sizes in the studies available. Available evidence compiles heterogeneous pathologic diagnoses and is limited by case-by-case follow-up, which makes extrapolation of results difficult. Nonetheless, short-term surrogate markers of oncologic success, such as margin status and lymph node harvest, are comparable to open procedures. Unfortunately disease recurrence and long-term survival data are lacking. In this review we explore the evidence available regarding laparoscopic resection of pancreatic adenocarcinoma, a promising approach for future widespread application.
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Boggi U, Amorese G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Mosca F. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc 2014; 29:9-23. [PMID: 25125092 DOI: 10.1007/s00464-014-3670-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 05/31/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic pancreaticoduodenectomy (LPD) is gaining momentum, but there is still uncertainty regarding its safety, reproducibility, and oncologic appropriateness. This review assesses the current status of LPD. METHODS Our literature review was conducted in Pubmed. Articles written in English containing five or more LPD were selected. RESULTS Twenty-five articles matched the review criteria. Out of a total of 746 LPD, 341 were reported between 1997 and 2011 and 405 (54.2 %) between 2012 and June 1, 2013. Pure laparoscopy (PL) was used in 386 patients (51.7 %), robotic assistance (RA) in 234 (31.3 %), laparoscopic assistance (LA) in 121 (16.2 %), and hand assistance in 5 (0.6 %). PL was associated with shorter operative time, reduced blood loss, and lower rate of pancreatic fistula (vs LA and RA). LA was associated with shorter operative time (vs RA), but with higher blood loss and increased incidence of pancreatic fistula (vs PL and RA). Conversion to open surgery was required in 64 LPD (9.1 %). Operative time averaged 464.3 min (338-710) and estimated blood 320.7 mL (74-642). Cumulative morbidity was 41.2 %, and pancreatic fistula was reported in 22.3 % of patients (4.5-52.3 %). Mean length of hospital stay was 13.6 days (7-23), showing geographic variability (21.9 days in Europe, 13.0 days in Asia, and 9.4 days in the US). Operative mortality was 1.9 %, including one intraoperative death. No difference was noted in conversion rate, incidence of pancreatic fistula, morbidity, and mortality when comparing results from larger (≥30 LPD) and smaller (≤29 LPD) series. Pathology demonstrated ductal adenocarcinoma in 30.6 % of the specimens, other malignant tumors in 51.7 %, and benign tumor/disease in 17.5 %. The mean number of lymph nodes examined was 14.4 (7-32), and the rate of microscopically positive tumor margin was 4.4 %. CONCLUSIONS In selected patients, operated on by expert laparoscopic pancreatic surgeons, LPD is feasible and safe.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy,
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The state of the art of robotic pancreatectomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:920492. [PMID: 24982913 PMCID: PMC4058602 DOI: 10.1155/2014/920492] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 12/31/2022]
Abstract
During the last decades an increasing number of minimally invasive pancreatic resections have been reported in the literature. With the development of robotic surgery a new enthusiasm has not only increased the number of centers approaching minimally invasive pancreatic surgery in general but also enabled the use of this technique for major pancreatic procedures, in particular in minimally invasive pancreatoduodenectomy. The aim of this review was to define the state of the art of pancreatic robotic surgery. No prospective randomized trials have been performed comparing robotic, laparoscopic, and open pancreatic procedures. From the literature one may conclude that robotic pancreatectomies seem to be as feasible and safe as open procedures. The general idea that the overall perioperative costs of robotic surgery would be higher than traditional procedures is not supported. With the current lack of evidence of any oncologic advantages, the cosmetic benefits offered by robotic surgery are not enough to justify extensive use in cancer patients. In contrast, the safety of these procedure can justify the use of the robotic technique in patient with benign/low grade malignant tumors of the pancreas.
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A Comparative Review Between Laparoscopic and Robotic Pancreaticoduodenectomies. Surg Laparosc Endosc Percutan Tech 2014; 24:103-8. [DOI: 10.1097/sle.0b013e3182a2f0ad] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Retrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg 2014; 18:682-9. [PMID: 24234245 DOI: 10.1007/s11605-013-2410-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/31/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND As with other open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) may result in decreased pain, fewer wound complications, and accelerated recovery. However, when used for periampullary cancers, it is also important to assess if MIPD offers comparable oncologic outcomes. METHODS Technical and perioperative outcomes were compared between patients with a preoperative diagnosis of periampullary neoplasm offered MIPD or open pancreaticoduodenectomy (OPD) from November 2009 to July 2011. RESULTS Fifty-six consecutive MIPD and OPD (28 each) procedures were analyzed. Comparing MIPD to OPD, significant differences included longer median procedure time (431 vs 410 min, p = .04) and fewer median lymph nodes harvested (15 vs. 20, p = .04). R0 resection rate tended to be lower (63 vs. 88%, p = .07) as well as surgical site infections (18 vs. 43 %, p = .08). Clinically significant pancreatic fistula rate was the same between groups (21%). Other outcomes such as narcotic pain medication use, length of stay, and 30-day readmission rates were also similar. CONCLUSIONS MIPD is feasible with comparable technical success and outcomes to OPD. However, there is a learning curve to the procedure and further experience and prospective study will be required to better establish the oncologic efficacy of MIPD to open resection.
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40
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Bencini L, Bernini M, Farsi M. Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution. World J Gastroenterol 2014; 20:1777-1789. [PMID: 24587655 PMCID: PMC3930976 DOI: 10.3748/wjg.v20.i7.1777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/07/2013] [Accepted: 11/30/2013] [Indexed: 02/06/2023] Open
Abstract
After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.
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Abstract
PURPOSE Pancreaticoduodenectomy (PD) is the treatment of choice for periampullary disease. Even with the increasing number of successful reports from around the globe, laparoscopic pancreaticoduodenectomy (LPD) is still not fully accepted. We report the results of our experience of LPD assisted by mini-laparotomy. METHOD This retrospective review study included 42 patients who received LPD assisted by mini-laparotomy between March 2009 and April 2012. Clinical outcomes, such as patient age, pathologic diagnosis, pancreas nature, operation time, conversion rate, hospital stay, postoperative complication, and mortality rates, were reviewed. RESULTS A total of 42 patients (age range, 42 to 70 y ) received LPD assisted by mini-laparotomy. The mean incision length for the laparotomy was 5.2 cm. Mean operative time was 404 minutes, and 3 cases required conversion to open surgery. Mean postoperative hospital stay was 17 days. There were 3 cases of pancreaticogastrostomy leakage, 2 cases of postoperative bleeding, 4 cases of delayed gastric emptying, 1 case of bile leakage, and 5 cases of pulmonary complications. Of the 5 patients with pulmonary complications, 1 died. CONCLUSIONS When performed by a surgeon with ample experience in laparoscopic surgery, LPD assisted by mini-laparotomy is a safe, feasible alternative to conventional PD for select cases. The method described in this study can be used to perform pancreaticoenteric anastomosis in the same manner as an open PD, while taking advantage of the merits of minimally invasive surgery.
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Kuroki T, Eguchi S. Laparoscopic parenchyma-sparing pancreatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:323-7. [PMID: 24027045 DOI: 10.1002/jhbp.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In recent years laparoscopic pancreatic procedures have developed rapidly, and reports of laparoscopic resection including laparoscopic distal pancreatectomy and laparoscopic pancreaticoduodenectomy have increased in number. On the other hand, many benign and low-grade malignant pancreatic lesions have recently been detected by the improved diagnostic modalities. Parenchyma-sparing pancreatectomy is a preferred surgical procedure for such benign and low-malignancy pancreatic lesions, because parenchyma-sparing pancreatectomy can avoid the unnecessary resection of the normal pancreatic parenchyma, thereby preserving the endocrine and exocrine functions of the pancreas. Simultaneously, laparoscopic surgery has contributed to minimally invasive approaches for various pancreatic surgical procedures. The combination of laparoscopic surgery and parenchyma-sparing pancreatectomy is an ideal surgical procedure for benign and low-grade malignant pancreatic lesions. For laparoscopic parenchyma-sparing pancreatectomy to become more widely known and its indications clarified, it is necessary to demonstrate the clinical benefits, technical feasibility, and safety of this complex and difficult surgical procedure.
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Affiliation(s)
- Tamotsu Kuroki
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
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Cirocchi R, Partelli S, Trastulli S, Coratti A, Parisi A, Falconi M. A systematic review on robotic pancreaticoduodenectomy. Surg Oncol 2013; 22:238-46. [PMID: 24060451 DOI: 10.1016/j.suronc.2013.08.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Robotic surgery might have several advantages in respect of the laparoscopic approach since might make more feasible the execution of a complex procedure such as pancreaticoduodenectomy (PD). The aim of the present systematic review is to evaluate the current state of the literature on robotic PD. METHODS A systematic literature search was performed, from January 1st 2003 to July 31st 2012, for studies which reported PDs performed for neoplasm and in which at least one surgical reconstructive or resective step was robotically performed. RESULTS Thirteen studies, representing 207 patients, met the inclusion criteria. The definition of the robotic approach was heterogeneous since the technique was defined as robotic, robotic-assisted, robot-assisted laparoscopic and robotic hybrid. Resection and reconstruction steps of robotic PD were also heterogeneous combining sequentially different approaches: totally robotic technique, laparoscopic-robotic resection and robotic reconstruction, laparoscopic resection and robotic reconstruction, hand port-assisted laparoscopic resection and robotic reconstruction, laparoscopic-robotic resection and reconstruction through mini-laparotomy. As regard the type of PD 66% were classic Whipple operations and 34% pylorus-preserving pancreatoduodenectomies. The management of pancreatic stump was a pancreaticogastrostomy in 23%, end-to-side pancreaticojejunostomy in 67%, and fibrin glue occlusion of the main pancreatic duct in 10% of cases. The overall procedure failure (rates of conversion to open surgery) was 14%. The overall morbidity rate was 58% and the reoperation rate was 7.3%. CONCLUSIONS There have been an increasing number of recent case series suggesting increased utilization of robotic PD over the past decade. The technical approach is heterogenous. For highly selected patient, robotic PD is feasible with similar morbidity and mortality compared to open or purely laparoscopic approaches. Data on cost analysis are lacking and further studies are needed to evaluate also the cost-effectiveness of the robotic approach for PD in comparison to open or laparoscopic techniques. The current state of the art analysis on robotic DP can be also useful in planning future trials.
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Affiliation(s)
- Roberto Cirocchi
- General Surgery, St. Maria Hospital, University of Perugia, Italy.
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Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F. Feasibility of robotic pancreaticoduodenectomy. Br J Surg 2013; 100:917-25. [PMID: 23640668 DOI: 10.1002/bjs.9135] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic pancreaticoduodenectomy is feasible, but requires adaptations to established surgical techniques. The improved dexterity offered by robotic assistance provides the opportunity to see whether laparoscopic pancreaticoduodenectomy can be performed safely when faithfully reproducing the open operation. METHODS Patients were selected for robotic pancreaticoduodenectomy when generally suitable for laparoscopy. Obese patients were excluded, and those with pancreatic cancer were highly selected. A prospectively designed database was used for data collection and analysis. RESULTS Of 238 patients undergoing pancreaticoduodenectomy, 34 (14·3 per cent) were operated on robotically. No procedure was converted to conventional laparoscopy or open surgery, despite three patients requiring segmental resection of the superior mesenteric/portal vein and reconstruction. The mean duration of operation was 597 (range 420-960) min. The mean number of lymph nodes retrieved and analysed from patients with neoplasia was 32 (range 15-76). Four patients required blood transfusions and five developed postoperative complications exceeding Clavien-Dindo grade II. There were four grade B pancreatic fistulas. One patient died on postoperative day 40. Excess mean operative cost compared with open resection was €6193. CONCLUSION Selected patients can safely undergo robotic pancreaticoduodenectomy. The main downsides are high costs and prolonged operating times compared with open resection.
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Affiliation(s)
- U Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy.
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Gumbs AA, Croner R, Rodriguez A, Zuker N, Perrakis A, Gayet B. 200 consecutive laparoscopic pancreatic resections performed with a robotically controlled laparoscope holder. Surg Endosc 2013; 27:3781-91. [PMID: 23644837 DOI: 10.1007/s00464-013-2969-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/03/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Because of the potential benefit of robotics in pancreatic surgery, we review our experience at two minimally invasive pancreatic surgery centers that utilize a robotically controlled laparoscope holder to see if smaller robots that enable the operating surgeon to maintain contact with the patient may have a role in the treatment of pancreatic disease. METHODS From March 1994 to June 2011, a total of 200 laparoscopic pancreatic procedures utilizing a robotically controlled laparoscope holder were performed. RESULTS A total of 72 duodenopancreatectomies, 67 distal pancreatectomies, 23 enucleations, 20 pancreatic cyst drainage procedures, 5 necrosectomies, 5 atypical pancreatic resections, 4 total pancreatectomies, and 4 central pancreatectomies were performed. Fourteen patients required conversion to an open approach and eight a hand-assisted one. A total of 24 patients suffered a major complication. Sixteen patients developed a pancreatic leak and 19 patients required reoperation. Major complications occurred in 14 patients and pancreatic leaks occurred in 13 patients. Ten patients required conversion to a lap-assisted or open approach and six patients required reoperation. CONCLUSIONS Currently, a robotically assisted approach using a camera holder seems the only way to incorporate some of the benefits of robotics in pancreatic surgery while maintaining haptics and contact with the patient.
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Affiliation(s)
- Andrew A Gumbs
- Department of Surgical Oncology, Summit Medical Group, Berkeley Heights, NJ, 07922, USA,
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Strijker M, van Santvoort HC, Besselink MG, van Hillegersberg R, Borel Rinkes IHM, Vriens MR, Molenaar IQ. Robot-assisted pancreatic surgery: a systematic review of the literature. HPB (Oxford) 2013; 15:1-10. [PMID: 23216773 PMCID: PMC3533705 DOI: 10.1111/j.1477-2574.2012.00589.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/30/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND To potentially improve outcomes in pancreatic resection, robot-assisted pancreatic surgery has been introduced. This technique has possible advantages over laparoscopic surgery, such as its affordance of three-dimensional vision and increased freedom of movement of instruments. A systematic review was performed to assess the safety and feasibility of robot-assisted pancreatic surgery. METHODS The literature published up to 30 September 2011 was systematically reviewed, with no restrictions on publication date. Studies reporting on over five patients were included. Animal studies, studies not reporting morbidity and mortality, review articles and conference abstracts were excluded. Data were extracted and weighted means were calculated. RESULTS A total of 499 studies were screened, after which eight cohort studies reporting on a total of 251 patients undergoing robot-assisted pancreatic surgery were retained for analysis. Weighted mean operation time was 404 ± 102 min (510 ± 107 min for pancreatoduodenectomy only). The rate of conversion was 11.0% (16.4% for pancreatoduodenectomy only). Overall morbidity was 30.7% (n = 77), most frequently involving pancreatic fistulae (n = 46). Mortality was 1.6%. Negative surgical margins were obtained in 92.9% of patients. The rate of spleen preservation in distal pancreatectomy was 87.1%. CONCLUSIONS Robot-assisted pancreatic surgery seems to be safe and feasible in selected patients and, in left-sided resections, may increase the rate of spleen preservation. Randomized studies should compare the respective outcomes of robot-assisted, laparoscopic and open pancreatic surgery.
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Affiliation(s)
- Marin Strijker
- Department of Surgery, University Medical Centre, Utrecht, the Netherlands
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Zhan Q, Deng XX, Han B, Liu Q, Shen BY, Peng CH, Li HW. Robotic-assisted pancreatic resection: a report of 47 cases. Int J Med Robot 2012; 9:44-51. [PMID: 23225335 DOI: 10.1002/rcs.1475] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are few reports of robot-assisted pancreatic surgery. Our purpose was to report our surgical and clinical experiences and outcomes of 47 cases of robot-assisted pancreatic resection to show that minimally invasive pancreatic surgery is both feasible and effective. METHODS The medical records of 47 patients who underwent robot-assisted pancreatic resections for adenocarcinoma, cystic tumours or other pancreatic diseases at our institution by a single surgical team from March 2010 to December 2011 were retrospectively analysed. RESULTS There were 32 females and 15 males with a mean age of 48.7 ± 15.4 years, of whom 13 patients had pathologically diagnosed malignancies, 25 had cystic tumours or chronic pancreatitis, three had solid pseudopapillary tumours of pancreas, and six had other lesions. Sixteen patients underwent pancreatoduodenectomy, 16 distal pancreatectomies (nine of which had spleen resections), 10 middle pancreatectomies, four Beger's procedure, and one had enucleation of a pancreatic lesion. The mean surgical time was 299.2 ± 133.5 (range 70-540) min and mean blood loss was 431.8 ± 309.0 (range 50-1100) ml. Nine patients required a blood transfusion (mean transfusion volume 597.2 ± 543.3 ml). There were no conversions to laparotomy. The mean hospital stay was 29.4 ± 9.1 (range 8-41) days. Pancreatic fistula occurred in 20 cases, anastomotic bleeding in three patients and anastomotic leakage in one patient. Two patients, one who received a PD and one who received a distal pancreatectomy, required a second surgery. All other complications were resolved with conservative management. Surgical margins were negative in all cases, with a postoperative histopathological diagnosis of malignancy. Eleven of the 13 patients with malignancies were alive and well without recurrence at the time of publication, while two patients died. CONCLUSIONS Our series of 47 robot-assisted pancreatic resections adds further evidence that this technique is feasible and effective.
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Affiliation(s)
- Qian Zhan
- Department of General Surgery, Ruijin Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai, People's Republic of China
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Fisher SB, Kooby DA. Laparoscopic pancreatectomy for malignancy. J Surg Oncol 2012; 107:39-50. [PMID: 22991263 DOI: 10.1002/jso.23253] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/09/2012] [Indexed: 12/15/2022]
Abstract
Utilization of laparoscopic techniques for resection of the pancreas has slowly gained acceptance in specific situations and is now being applied to more challenging endeavors, such as pancreaticoduodenectomy for cancer. This review provides a summary of laparoscopic applications for pancreatic malignancy, with specific attention to the most common methods of pancreatic resection and their respective oncologic outcomes, including margin status, lymph node retrieval, and survival.
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Affiliation(s)
- Sarah B Fisher
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Abstract
Pancreatic surgery is challenging for both surgeon and patient. With the advent of minimally invasive surgical techniques, patient morbidity could be reduced. However, these techniques must conform to established principles of open pancreatic surgery with regards to meticulous dissection, haemostasis and oncologic results. The robotic platform is utilized in all facets of surgery, and is being increasingly applied in pancreatic surgery. As with the introduction of any new technology, this approach must undergo rigorous examination before widespread adoption of the technique. In this article, we review the techniques and outcomes of robotic-assisted pancreatic resections, focusing on robotic-assisted pancreaticoduodenectomy, robotic-assisted distal pancreatectomy and robotic-assisted central pancreatectomy. As the outcomes of robotic-assisted surgery have yet to be rigorously evaluated against the gold standard of open surgery, this Review also highlights major laparoscopic pancreatic series in an effort to summarize the available literature on minimally invasive pancreatic surgery.
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Horiguchi A, Uyama I, Ito M, Ishihara S, Asano Y, Yamamoto T, Ishida Y, Miyakawa S. Robot-assisted laparoscopic pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:488-92. [PMID: 21491102 DOI: 10.1007/s00534-011-0383-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In the field of gastroenterological surgery, laparoscopic surgery has advanced remarkably, and now accounts for most gastrointestinal operations. This paper outlines the current status of and future perspectives on robot-assisted laparoscopic pancreatectomy. METHODS A review of the literature and authors' experience was undertaken. RESULTS The da Vinci Surgical System is a robot for assisting laparoscopy and is safer than conventional endoscopes, thanks to the 3-dimensional hi-vision images it yields, high articular function with the ability to perform 7 types of gripping, scaling function enabling 2:1, 3:1, and 5:1 adjustment of surgeon hand motion and forceps motions, a filtering function removing shaking of the surgeon's hand, and visual magnification. By virtue of these functions, this system is expected to be particularly useful for patients requiring delicate operative manipulation. CONCLUSIONS Issues of importance remaining in robot-assisted laparoscopic pancreatectomy include its time of operation, which is longer than that of open surgery, and the extra time needed for application of the da Vinci compared with ordinary laparoscopic surgery. These issues may be resolved through accumulation of experience and modifications of the procedure. Robot-assisted laparoscopic pancreatectomy appears likely to become a standard procedure in the near future.
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Affiliation(s)
- Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University, 1-98 Dengakugakubo Kutsukakecho, Toyoake, Aichi, Japan.
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