Indications, technique, and results of robotic pancreatoduodenectomy.
Robotic assistance improves surgical dexterity in minimally invasive operations, especially when fine dissection and multiple sutures are required. As such, robotic assistance could be rewarding in the setting of robotic pancreatoduodenectomy (RPD). RPD was implemented at a high volume center with preemptive experience in advanced laparoscopy. Indications, surgical technique, and results of RPD are discussed against the background of current literature. RPD was performed in 112 consecutive patients. Conversion to open surgery was required in three patients, despite nine required segmental resection and reconstruction of the superior mesenteric/portal vein. No patient was converted to laparoscopy. A pancreato-jejunostomy was created in 106 patients (94.6 %), using either a duct-to-mucosa (n = 82; 73.2 %) or an invaginating (n = 24; 21.4 %) technique. Pancreato-gastrostomy was performed in one patient, the pancreatic duct was occluded in two patients, and a pancreatico-cutaneous fistula was created in three patients. Mean operative time was 526.3 ± 102.4 in the entire cohort and reduced significantly over the course of time. Experience was also associated with reduced rates of delayed gastric emptying and increased proportion of malignant tumor histology. Ninety day mortality was 3.6 %. Postoperative complications occurred in 83 patients (74.1 %) with a median comprehensive complication index of 20.9 (0-30.8). Clinically relevant pancreatic fistula occurred in 19.6 % of the patients. No grade C pancreatic fistula was noted in the last 72 consecutive patients. RPD is safely feasible in selected patients. Implementation of RPD requires sound experience with open pancreatoduodenectomy and advanced laparoscopic procedures, as well as specific training with the robotic platform.
['Napoli|Niccolò|N|', 'Kauffmann|Emanuele F|EF|', 'Menonna|Francesca|F|', 'Perrone|Vittorio Grazio|VG|', 'Brozzetti|Stefania|S|', 'Boggi|Ugo|U|']
D061887:Conversion to Open Surgery D005240:Feasibility Studies D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D007558:Italy D010535:Laparoscopy D008297:Male D008875:Middle Aged D061646:Operative Time D010179:Pancreas D010190:Pancreatic Neoplasms D016577:Pancreaticoduodenectomy D011183:Postoperative Complications D012189:Retrospective Studies D012371:Robotics D016896:Treatment Outcome
Robot Pancreatoduodenectomy Laparoscopy Pancreatectomy da Vinci