Skip to main content

Advertisement

SpringerLink
Log in

Robotic versus open total pancreatectomy: a retrospective cohort study

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Robotic total pancreatectomy (RTP), although considered safe and feasible, has rarely been reported. This study aimed to evaluate whether RTP has advantages over open TP (OTP).

Methods

Demographics and perioperative outcomes among patients who underwent RTP (n=14) versus OTP (n=15) between May 2015 and September 2020 were retrospectively analyzed.

Results

RTP reduced the operative time (307.2 vs. 382.0 min, p=0.01) and estimated blood loss (EBL) (200 vs. 700 ml, p=0.002) compared to those of OTP. The patients in the RTP group got out of their beds and stood, received their first liquid, and took oral diets earlier (2.0 vs. 3.0 days, p=0.002; 2.0 vs. 4.0 days, p=0.009; 3.0 vs. 5.0 days, p=0.006) and experienced a shorter postoperative hospital stay (PHS) (9.0 vs. 12.0 days, p=0.03). There were no significant differences in the rates of spleen preservation, splenic vessel preservation, bile leakage, delayed gastric emptying, morbidity, or the number of lymph nodes harvest between the two groups.

Conclusion

This study demonstrates that RTP is safe and feasible in selected patients with different indications in experienced robotic center. RTP was associated with a shorter operative time, lower EBL, and shorter PHS than OTP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Reddy S, Wolfgang CL, Cameron JL et al (2009) Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg 250:282–287

    Article  Google Scholar 

  2. Heidt DG, Burant C, Simeone DM (2007) Total pancreatectomy: indications, operative technique, and postoperative sequelae. J Gastrointest Surg 11:209–216

    Article  Google Scholar 

  3. ReMine WH, Priestley JT, Judd ES, King JN (1970) Total pancreatectomy. Ann Surg 172:595–604

    Article  CAS  Google Scholar 

  4. Bhayani NH, Miller JL, Ortenzi G, Kaifi JT, Kimchi ET, Staveley-O’Carroll KF, Gusani NJ (2014) Perioperative outcomes of pancreaticoduodenectomy compared to total pancreatectomy for neoplasia. J Gastrointest Surg 18:549–554

    Article  Google Scholar 

  5. Müller MW, Friess H, Kleeff J et al (2007) Is there still a role for total pancreatectomy? Ann Surg 246:966–974 discussion 974-965

    Article  Google Scholar 

  6. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255:1048–1059

    Article  Google Scholar 

  7. Palanivelu C, Senthilnathan P, Sabnis SC (2017) Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg 104:1443–1450

    Article  CAS  Google Scholar 

  8. Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

    Article  Google Scholar 

  9. Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ (2011) Robotic-assisted major pancreatic resection and reconstruction. Arch Surg 146:256–261

    Article  Google Scholar 

  10. Liu Q, Zhao Z, Gao Y, Zhao G, Tan X, Wang C, Liu R (2020) Novel single-layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 27:56–63

    PubMed  Google Scholar 

  11. Shi Y, Wang W, Qiu W et al (2019) Learning curve from 450 cases of robot-assisted pancreaticoduocectomy in a high-volume pancreatic center: optimization of operative procedure and a retrospective study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003664

  12. Zureikat AH, Beane JD, Zenati MS et al (2021) 500 minimally invasive robotic pancreatoduodenectomies: one decade of optimizing performance. Ann Surg 273:966–972

    Article  Google Scholar 

  13. Zureikat AH, Nguyen T, Boone BA, Wijkstrom M, Hogg ME, Humar A, Zeh H III (2015) Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach. Surg Endosc 29:176–183

    Article  Google Scholar 

  14. Giulianotti PC, Addeo P, Buchs NC, Bianco FM, Ayloo SM (2011) Early experience with robotic total pancreatectomy. Pancreas 40:311–313

    Article  Google Scholar 

  15. Galvani CA, Rodriguez Rilo H, Samamé J, Porubsky M, Rana A, Gruessner RW (2014) Fully robotic-assisted technique for total pancreatectomy with an autologous islet transplant in chronic pancreatitis patients: results of a first series. J Am Coll Surg 218:e73–e78

    Article  Google Scholar 

  16. Brecher ME, Monk T, Goodnough LT (1997) A standardized method for calculating blood loss. Transfusion 37:1070–1074

    Article  CAS  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  18. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  Google Scholar 

  19. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    Article  Google Scholar 

  20. Chun YS, Pawlik TM, Vauthey JN (2018) 8th Edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol 25:845–847

    Article  Google Scholar 

  21. Crippa S, Tamburrino D, Partelli S et al (2011) Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery 149:79–86

    Article  Google Scholar 

  22. Okabe H, Obama K, Tanaka E, Tsunoda S, Akagami M, Sakai Y (2013) Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric Cancer 16:268–274

    Article  Google Scholar 

  23. Reichenbach DJ, Tackett AD, Harris J et al (2006) Laparoscopic colon resection early in the learning curve: what is the appropriate setting? Ann Surg 243:730–735 discussion 735-737

    Article  Google Scholar 

  24. Wang X, Li Y, Cai Y, Liu X, Peng B (2017) Laparoscopic total pancreatectomy: case report and literature review. Medicine (Baltimore) 96:e5869

    Article  Google Scholar 

  25. Choi SH, Hwang HK, Kang CM, Yoon CI, Lee WJ (2012) Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surg Endosc 26:2072–2077

    Article  Google Scholar 

  26. Boggi U, Palladino S, Massimetti G et al (2015) Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study. Surg Endosc 29:1425–1432

    Article  Google Scholar 

  27. Zhang T, Zhao ZM, Gao YX, Lau WY, Liu R (2019) The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center. Surg Endosc 33:2927–2933

    Article  Google Scholar 

  28. Boone BA, Zenati M, Hogg ME et al (2015) Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg 150:416–422

    Article  Google Scholar 

  29. Shakir M, Boone BA, Polanco PM et al (2015) The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford) 17:580–586

    Article  Google Scholar 

  30. Shi Y, Jin J, Qiu W et al (2020) Short-term outcomes after robot-assisted vs open pancreaticoduodenectomy after the learning curve. JAMA Surg 155:1–6

    Article  Google Scholar 

  31. Miura F, Takada T, Asano T, Kenmochi T, Ochiai T, Amano H, Yoshida M (2005) Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery 138:518–522

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Xiaomo Li from Genetron Health (Beijing) Technology, Co. Ltd for her assistance with the figures.

Author information

Author notes

  1. WW, QL, and ZZ contributed equally to this work, and should be considered first author.

Authors and Affiliations

  1. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Wei Wang, Qu Liu, Zhiming Zhao, Xianglong Tan, Guodong Zhao & Rong Liu

  2. Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China

    Wei Wang

Authors
  1. Wei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhiming Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xianglong Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guodong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: WW, QL, ZZ, and RL. Performance of operation: ZZ, GZ and RL. Drafting of the manuscript: WW, QL, and ZZ. Data collection and analysis: WW, QL, ZZ, and XT. Critical revision of the manuscript for important intellectual content: WW, QL, ZZ, and RL. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rong Liu.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from patient for publication of this report and any associated images.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, W., Liu, Q., Zhao, Z. et al. Robotic versus open total pancreatectomy: a retrospective cohort study. Langenbecks Arch Surg 406, 2325–2332 (2021). https://doi.org/10.1007/s00423-021-02202-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02202-z

Keywords

Search

Navigation