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Hybrid pancreatoduodenectomy in laparoscopic and robotic surgery: a single-center experience in China

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Abstract

Background

Minimally invasive surgery is beneficial for pancreatic surgery, and the indication has been expanded to pancreatoduodenectomy (PD). The aim of this study was to share our experiences with hybrid PD in laparoscopic and robotic surgery.

Methods

Sixty-four patients underwent hybrid PD in which specimen resection and gastrojejunostomy were performed through the laparoscopic route and pancreatojejunostomy and hepaticojejunostomy were performed via a robotic approach by the same surgeon at a single institution between July 2016 and June 2019. The primary endpoint was complications; secondary endpoints were operative time (OT), the length of hospital stay, and blood loss. The data for the patients were retrospectively obtained from electrical medical records.

Results

All patients underwent surgery with the hybrid procedure. The mean OTs and estimated blood loss (EBL) were 309.7 ± 77.6 min (range 17–620 min), 160 ± 31.7 mL (range 50–800 mL). The mean number of lymph nodes retrieved was 7.3 ± 6.7 (range 0–37), and that among 45 malignant cases was 8.42 ± 6.7 (range 1–37). The average length of postoperative stay in the hospital was 11.14 ± 7.03 days (range 6–47 days). Clinically relevant postoperative pancreatic fistulas (POPFs) occurred in 39 (60.9%) cases, and most were biochemical leak POPF (29 cases, 45.3%); only 10 (15.6%) cases were grade B/C (8 cases were Grade B and 2 cases were Grade C treated with digital subtraction angiography). Bile leakage occurred in 2 (3.1%) patients. One (1.5%) patient had a gastric fistula, and 3 (4.7%) developed postoperative delayed gastric emptying categorized as International Study Group of Pancreatic Surgery (ISGPS) Grade A. Three (4.7%) patients were readmitted for postoperative bleeding, and 2 (3.1%) died within 30 days.

Conclusion

Hybrid PD with laparoscopic and robot surgery is safe and feasible. OT can be reduced by switching from the laparoscopic approach to the robotic procedure at the appropriate timepoint.

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Acknowledgements

Da-Bin Xu and Zhi-Ming Zhao contributed equally to this work, and both should be considered first author.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese Medical School, 28 Fuxing Road, Haidian District, Beijing, 100853, China

    Da-Bin Xu, Zhi-Ming Zhao, Yong Xu & Rong Liu

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Correspondence to Rong Liu.

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Da-Bin Xu, Zhi-Ming Zhao, Yong Xu, Yong Liu have no conflicts of interest or financial ties to disclose.

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Xu, DB., Zhao, ZM., Xu, Y. et al. Hybrid pancreatoduodenectomy in laparoscopic and robotic surgery: a single-center experience in China. Surg Endosc 35, 1703–1712 (2021). https://doi.org/10.1007/s00464-020-07557-w

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  • DOI: https://doi.org/10.1007/s00464-020-07557-w

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