[A Single-team Experience with Robotic Pancreatic Surgery in 1010 Cases]

Overview

Journal Nan Fang Yi Ke Da Xue Xue Bao

Specialty General Medicine

Date 2018 Mar 5

PMID 29502049

Citations 9

Authors

Rong Liu

Guo-Dong Zhao

Wen-Bo Tang

Ke-Di Zhang

Zhi-Ming Zhao

Yuan-Xing Gao

Ming-Gen Hu

Cheng-Gang Li

Xiang-Long Tan

Xuan Zhang

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.

Methods: The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.

Results: The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.

Conclusion: This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.

Citing Articles

International consensus guidelines on robotic pancreatic surgery in 2023.

Liu R, Abu Hilal M, Besselink M, Hackert T, Palanivelu C, Zhao Y Hepatobiliary Surg Nutr. 2024; 13(1):89-104.

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[Anastomotic techniques in minimally invasive hepatobiliopancreatic surgery].

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A comparative study of end-to-end pancreatic anastomosis versus pancreaticojejunostomy after robotic central pancreatectomy.

Wang Z, Zhao G, Zhao Z, Hu M, Tan X, Zhang X Updates Surg. 2021; 73(3):967-975.

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Pancreatic head cancer: Open or minimally invasive pancreaticoduodenectomy?.

Feng M, Cao Z, Sun Z, Zhang T, Zhao Y Chin J Cancer Res. 2020; 31(6):862-877.

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Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia.

Goh B, Zeng G, Low T, Chua D, Koh Y, Lim K J Minim Access Surg. 2020; 16(4):341-347.

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