Skip to main content
SpringerLink
Log in

Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Advanced and delicate laparoscopic techniques are usually required for safe and successful laparoscopic spleen-preserving distal pancreatectomy. The unique characteristics of robotic surgical system are thought to be useful for this minimally invasive procedure.

Methods

From September 2007 to May 2011, patients who underwent robot-assisted, spleen-preserving, distal pancreatectomy for benign and borderline malignant tumors of the pancreas were retrospectively reviewed. Perioperative clinicopathologic surgical outcomes were evaluated.

Results

Twenty-two patients were attempted for robot-assisted, spleen-preserving, distal pancreatectomy, and in 21 patients (95.5 %), the spleen was saved either by splenic vessels conservation (SVC; n = 17, 81 %) or by splenic vessels sacrifice (SVS; n = 4, 19 %). Seven patients were male and 15 were female with a mean age of 43.2 ± 15.2 years. Pathologic diagnosis included MCT in five patients, SCT in five, SPT in four, IPMT in three, NET in three, and other benign conditions in two. The mean operation time was 398.9 ± 166.3 min, but it gradually decreased as experiences were accumulated (Rsq = 0.223, p = 0.023). Intraoperative blood loss was 361.3 ± 360.1 ml, and intraoperative transfusion was required in four patients (18.1 %). A soft diet was given for 1.2 ± 0.4 days, and the length of hospital stay was 7.0 ± 2.4 days postoperatively. Clinically relevant pancreatic fistula was noted in two patients (9.1 %) but was successfully managed conservatively. Most patients (87.5 %) showed patency in conserved both splenic vessels, and only two patients (12.5 %) had partially or completely obliterated in splenic veins in the SVC-SpDP group. Partially impaired splenic perfusion was observed in one patient in the SVS-SpDP group. The perfusion defect area decreased without any clinical symptom after 4 months.

Conclusions

The robotic surgical system is thought to be beneficial for improving the spleen-preservation rate in laparoscopic distal pancreatectomy. Robot-assisted approach can be chosen for patients who require spleen-preserving distal pancreatectomy.

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
Fig. 3

Similar content being viewed by others

References

  1. Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park do H, Han DJ (2011) Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25:3364–3372

    Article  PubMed  Google Scholar 

  2. Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137

    Article  PubMed  Google Scholar 

  3. Yoon YS, Lee KH, Han HS, Cho JY, Ahn KS (2009) Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg 96:633–640

    Article  PubMed  Google Scholar 

  4. Hwang HK, Chung YE, Kim KA, Kang CM, Lee WJ (2012) Revisiting vascular patency after spleen-preserving laparoscopic distal pancreatectomy with conservation of splenic vessels. Surg Endosc

  5. Tien YW, Liu KL, Hu RH, Wang HP, Chang KJ, Lee PH (2010) Risk of varices bleeding after spleen-preserving distal pancreatectomy with excision of splenic artery and vein. Ann Surg Oncol 17:2193–2198

    Article  PubMed  Google Scholar 

  6. 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  PubMed  Google Scholar 

  7. Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268

    Article  PubMed  Google Scholar 

  8. Palanivelu C, Shetty R, Jani K, Sendhilkumar K, Rajan PS, Maheshkumar GS (2007) Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center. Surg Endosc 21:373–377

    Article  PubMed  CAS  Google Scholar 

  9. Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82

    Article  PubMed  Google Scholar 

  10. Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501

    Article  PubMed  Google Scholar 

  11. Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19:1028–1034

    Article  PubMed  CAS  Google Scholar 

  12. Ballantyne GH (2007) Telerobotic gastrointestinal surgery: phase 2–safety and efficacy. Surg Endosc 21:1054–1062

    Article  PubMed  CAS  Google Scholar 

  13. Talamini MA, Chapman S, Horgan S, Melvin WS (2003) A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 17:1521–1524

    Article  PubMed  CAS  Google Scholar 

  14. Ballentyne GH MJ, Giulianotti PC (2004) Primer of robotic & telerobotic surgery. ch. 22: 155-164

  15. Kim DH, Kang CM, Lee WJ, Chi HS (2011) The first experience of robot assisted spleen-preserving laparoscopic distal pancreatectomy in Korea. Yonsei Med J 52:539–542

    Article  PubMed  Google Scholar 

  16. Kim DH, Kang CM, Lee WJ, Chi HS (2011) Robotic central pancreatectomy with pancreaticogastrostomy (transgastric approach) in a solid pseudopapillary tumor of the pancreas. Hepatogastroenterology 58:1805–1808

    PubMed  Google Scholar 

  17. Kang CM, Kim DH, Lee WJ, Chi HS (2011) Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 25:2004–2009

    Article  PubMed  Google Scholar 

  18. Kang CM, Kim DH, Lee WJ, Chi HS (2011) Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy. Surg Endosc 25:1101–1106

    Article  PubMed  Google Scholar 

  19. Choi SH, Kang CM, Hwang HK, Lee WJ, Chi HS (2012) Robotic Anterior RAMPS in Well-Selected Left-Sided Pancreatic Cancer. J Gastrointest Surg

  20. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  21. Chung CT, Bogart JA, Adams JF, Sagerman RH, Numann PJ, Tassiopoulos A, Duggan DB (1997) Increased risk of breast cancer in splenectomized patients undergoing radiation therapy for Hodgkin’s disease. Int J Radiat Oncol Biol Phys 37:405–409

    Article  PubMed  CAS  Google Scholar 

  22. Schwarz RE, Harrison LE, Conlon KC, Klimstra DS, Brennan MF (1999) The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma. J Am Coll Surg 188:516–521

    Article  PubMed  CAS  Google Scholar 

  23. Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137:164–168

    Article  PubMed  Google Scholar 

  24. Guru KA, Hussain A, Chandrasekhar R, Piacente P, Bienko M, Glasgow M, Underwood W, Wilding G, Mohler JL, Menon M, Peabody JO (2009) Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons. Can J Urol 16:4736–4741 discussion 4741

    PubMed  Google Scholar 

  25. Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253:1060–1066

    Article  PubMed  Google Scholar 

  26. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249:927–932

    Article  PubMed  Google Scholar 

  27. Baik SH, Lee WJ, Rha KH, Kim NK, Sohn SK, Chi HS, Cho CH, Lee SK, Cheon JH, Ahn JB, Kim WH (2008) Robotic total mesorectal excision for rectal cancer using four robotic arms. Surg Endosc 22:792–797

    Article  PubMed  Google Scholar 

  28. Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, Chung KY (2010) Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg 139(53–59):e51

    Google Scholar 

  29. Miura F, Sano K, Amano H, Toyota N, Wada K, Kadowaki S, Shibuya M, Maeno S, Takada T, Hayano K, Matsubara H (2011) Is spleen-preserving distal pancreatectomy with excision of the splenic artery and vein feasible? Surgery 150:572

    Article  PubMed  Google Scholar 

  30. Warshaw AL (2010) Distal pancreatectomy with preservation of the spleen. J Hepatobiliary Pancreat Sci 17:808–812

    Article  PubMed  Google Scholar 

  31. Jones P, Leder K, Woolley I, Cameron P, Cheng A, Spelman D (2010) Postsplenectomy infection - strategies for prevention in general practice. Aust Fam Physician 39:383–386

    PubMed  Google Scholar 

  32. Kendrick ML, Sclabas GM (2011) Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford) 13:454–458

    Article  Google Scholar 

  33. Zureikat AH, Breaux JA, Steel JL, Hughes SJ (2011) Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg 15:1151–1157

    Article  PubMed  Google Scholar 

  34. Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145:19–23

    Article  PubMed  Google Scholar 

  35. Benoist S, Dugue L, Sauvanet A, Valverde A, Mauvais F, Paye F, Farges O, Belghiti J (1999) Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 188:255–260

    Article  PubMed  CAS  Google Scholar 

  36. Waghorn DJ (2001) Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol 54:214–218

    Article  PubMed  CAS  Google Scholar 

  37. Jockovich M, Mendenhall NP, Sombeck MD, Talbert JL, Copeland EM 3rd, Bland KI (1994) Long-term complications of laparotomy in Hodgkin’s disease. Ann Surg 219:615–621 discussion 621-614

    Article  PubMed  CAS  Google Scholar 

  38. Di Sabatino A, Carsetti R, Corazza GR (2011) Post-splenectomy and hyposplenic states. Lancet 378:86–97

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Ho Kyoung Hwang, Chang Moo Kang, Young Eun Chung, Kyung Ah Kim, Sung Hoon Choi, and Woo Jung Lee have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Ho Kyoung Hwang, Chang Moo Kang, Sung Hoon Choi & Woo Jung Lee

  2. Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea

    Young Eun Chung & Kyung Ah Kim

  3. Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Yonsei University Health System, Seoul, South Korea

    Ho Kyoung Hwang, Chang Moo Kang, Young Eun Chung, Kyung Ah Kim, Sung Hoon Choi & Woo Jung Lee

Authors
  1. Ho Kyoung Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Moo Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Eun Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyung Ah Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sung Hoon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Woo Jung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang Moo Kang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hwang, H.K., Kang, C.M., Chung, Y.E. et al. Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application. Surg Endosc 27, 774–781 (2013). https://doi.org/10.1007/s00464-012-2551-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2551-6

Keywords

Search

Navigation