Introducing robotic pancreas surgery through distal pancreatectomy

Background In recent years the role of robotic surgery in visceral surgery has become more prevalent. In particular laparoscopic distal pancreatectomy (LDP) is increasingly replaced by robotic distal pancreatectomy (RDP).Multiple studies have shown the benefit of minimal invasive surgery related to blood loss and length of hospital stay. Compared to patients who underwent open distal pancreatectomy (ODP) there is no significant difference in lymph node harvest and R-status.

Materials and method We analyzed retrospectively our prospectively collected data from February 2017 to April 2020 and compared 23 patients who underwent an ODP, to 28 RDP to answer the question whether DP is suitable for the implementation of robotic pancreas surgery.

Results The instantaneous effects of RDP were significant decrease blood loss and a shorter hospital stay (11,9 d vs. 22,1 d),especially in intensive care (1,07 d vs. 3 d).In several cases intensive care was no longer necessary.RDPs had a longer median operation time (355 min vs. 256 min) compared to ODPs however median operation time of RDP has since shortened at promising rate. After preliminary assessment some patients were found not to be eligible for RDP. Out of 50 patients 5 had to be converted from RDP to ODP. These patients presented with chronic pancreatitis and with a carcinoma in the pancreas body. This does not mean however that all patients presenting with these symptoms need to be converted to ODP or to be planned in for ODP, if the surgeon is experienced in RDP. There was no difference in the incidence of postoperative pancreatic fistula (ISGPF Grade B-C), major morbidity or other complications according to the clavien-dindo classification. There is no survival rate yet but there was more lymph node harvest seen in RDPs (24,71 vs. 18,56). In RDP 8,7% positive margin was seen vs. 23,5% in ODP.

Conclusion With an appropriate selection of patients for a distal pancreatectomy, RDP is found to be a safe method and should be established as the operative treatment of choice for selected patients. The possible increase in cost for robotic techniques can be offset by shorter length of hospital stay and reduced likelihood of intensive care.RDP is suitable as an introduction for robotic pancreatic surgery.

Publication History

Article published online:
08 September 2020