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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2015, Vol. 9 Issue (3) : 356-360     DOI: 10.1007/s11684-015-0404-0
RESEARCH ARTICLE |
Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes
Eric C. H. Lai(),Chung Ngai Tang
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
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Abstract  

Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

Keywords distal pancreatectomy      pancreatic neoplasm      robotic surgery     
Corresponding Authors: Eric C. H. Lai   
Just Accepted Date: 08 July 2015   Online First Date: 21 August 2015    Issue Date: 26 August 2015
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-015-0404-0     OR     http://academic.hep.com.cn/fmd/EN/Y2015/V9/I3/356
Variables Robotic approach (n?=?17) Conventional laparoscopic approach (n?=?18) P value
Gender (male: female) 10:7 4:14 0.035
Mean age (year) 61.2±10.4 (SD) 63.2±17.9 (SD) 0.701
The American Society of Anesthesiologists (ASA) Scores12 611 414 0.471
Mean body mass index (BMI) 24.1±2.3 (SD) 25.7±2.7 (SD) 0.067
Malignant pathology (%) 4 (23.5%) 2 (11.1%) 0.402
Type of pathology (n)Ca pancreasMetastasis from Ca colonSerous cyst adenomaMucinous cystic tumorPseudopapillary tumorAcinar cell csytadenomaNeuroendocrine tumorIntraductal papillary mucinous neoplasm (IPMN)Chronic pancreatitisPseudocyst 3162004100 2064112012 \
Tab.1  Patients’ characteristics and pathologies (one patient in laparoscopic group had double pathologies)
Variables Robotic approach (n?=?17) Conventional laparoscopic approach (n?=?18) P value
Spleen preservation (%) 9 (52.9%) 7 (38.9%) 0.505
Mean operation time (min) 221.4±73.2 (SD) 173.6±45.6 (SD) 0.026
Mean blood loss (ml) 100.3 (range, 10-300) 268.3 (range, 20-2600) 0.29
Morbidity (No. of patients with complications) (%) 8 (47.1%) 7 (38.9%) 0.73
Type of complication (%)Pancreatic fistulaPseudoaneurysm with bleedingIleusCollectionWound infection 7 (41.2%)1 (5.9%)1 (5.9%)1 (5.9%)1 (5.9%) 6 (33.3%)0 (0%)0 (0%)3 (16.7%)1 (5.6%) 0.730.470.470.601.0
30-day mortality (%) 0 (0%) 0 (0%) \
Mean length of stay (day) 11.4±6.9 (SD) 14.2±14 (SD) 0.46
Tab.2  Surgical outcomes
1 Lai EC, Tang CN. Current status of robot-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a comprehensive review. Asian J Endosc Surg 2013; 6(3): 158–164
doi: 10.1111/ases.12040 pmid: 23710970
2 Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, Caravaglios G, Coratti A. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 2010; 24(7): 1646–1657
doi: 10.1007/s00464-009-0825-4 pmid: 20063016
3 Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd. 250 robotic pancreatic resections: safety and feasibility. Ann Surg 2013; 258(4): 554–559, discussion 559-562
pmid: 24002300
4 Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM. Robotic distal pancreatectomy: cost effective? Surgery 2010; 148(4): 814–823
doi: 10.1016/j.surg.2010.07.027 pmid: 20797748
5 Kang CM, Kim DH, Lee WJ, Chi HS. Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 2011; 25(6): 2004–2009
doi: 10.1007/s00464-010-1504-1 pmid: 21136089
6 Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL, Hughes SJ, Lee KK, Moser AJ, Zeh HJ. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 2013; 257(1): 128–132
doi: 10.1097/SLA.0b013e31825fff08 pmid: 22868357
7 Lee SY, Allen PJ, Sadot E, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Kingham TP. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg 2015; 220(1): 18–27
doi: 10.1016/j.jamcollsurg.2014.10.004 pmid: 25456783
8 Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M; International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138(1): 8–13
doi: 10.1016/j.surg.2005.05.001 pmid: 16003309
9 Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 2007; 245(3): 443–451
doi: 10.1097/01.sla.0000251708.70219.d2 pmid: 17435552
10 Tang CN, Tsui KK, Ha JP, Wong DC, Li MK. Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterology 2007; 54(73): 265–271
pmid: 17419274
11 Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 2012; 26(4): 904–913
doi: 10.1007/s00464-011-2016-3 pmid: 22083328
12 Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 2012; 255(6): 1048–1059
doi: 10.1097/SLA.0b013e318251ee09 pmid: 22511003
13 Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery 1996; 120(6): 1051–1054
doi: 10.1016/S0039-6060(96)80054-7 pmid: 8957494
14 Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 1994; 39(3): 178–184
pmid: 7932341
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