Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection

• Published in: Surgical endoscopy Vol. 26; no. 9; pp. 2397 - 2402
• Main Authors: Chalikonda, S., Aguilar-Saavedra, J. R., Walsh, R. M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.09.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Applied sciences; Biological and medical sciences; Body mass index; Computer science; control theory; systems; Control theory. Systems; Digestive system. Abdomen; Endoscopy; Exact sciences and technology; Female; Gastroenterology; General aspects; Gynecology; Hepatology; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - methods; Laparotomy; Length of stay; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Pancreas; Pancreaticoduodenectomy; Pancreaticoduodenectomy - methods; Patients; Proctology; Prospective Studies; Robotic surgery; Robotics; Surgeons; Surgery; Veins & arteries; Pancreaticobiliary cancer; Surgical; Technical; Pancreatic; Endoscopic surgery; Duodenum; Digestive system; Laparoscopy; Malignant tumor; Small intestine; Robotics; Medicine; Treatment; Endoscopy; Technique; Pancreas; Comparative study; Cancer; Pancreatoduodenectomy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-012-2207-6

Background Minimally invasive procedures have expanded recently to include pancreaticoduodenectomy (PD), but the efficacy of a laparoscopic robotic-assisted approach has not been demonstrated. A case-matched comparison was undertaken to study outcomes between laparoscopic robotic approach (LRPD) and the conventional open counterpart (OPD). Methods From March 2009 through December 2010, 30 LRPD were performed by two pancreaticobiliary surgeons at the Cleveland Clinic. Thirty OPD patients operated by four pancreaticobiliary surgeons during this same period were matched by demographics, and postoperative outcomes were compared from review of a prospectively collected database. Results Mean age was 62 years for LRPD versus 61 years for OPD ( p  = 0.43). Mean body mass index was 24.8 versus 25.6 kg/m 2 ( p  = 0.49). Surgical indications included adenocarcinoma in 14 patients from each group (46%), intraductal papillary mucinous neoplasm in 4 (14%), and other in 12 (40%). There was one preoperative death in the LRPD group and none following OPD. Morbidity occurred in nine patients (30%) following LRPD versus 13 (44%) in the OPD group ( p  = 0.14). Intraoperative factors assessed included blood loss (485.8 vs 775 ml, p  = 0.13) and operative time (476.2 vs 366.4 min, p  = 0.0005). Conversion from LRPD to open occurred in three patients (12%) due to bleeding. Reoperation was performed in two patients (6%) following LRPD versus seven (24%) following OPD ( p  = 0.17). Length of hospital stay was 9.79 days for LRPD versus 13.26 days in the OPD group ( p  = 0.043). Conclusions This is the first comparison of a novel laparoscopic robotic-assisted PD with the open PD in a case-matched fashion. Our data demonstrate a significant increase in operative time but decreased length of stay for LRPD. The favorable morbidity following LRPD makes it a reasonable surgical approach for selected patients requiring PD.