Skip to main content

Advertisement

SpringerLink
Log in

Robotic-assisted versus laparoscopic left pancreatectomy at a high-volume, minimally invasive center

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

While minimally invasive left pancreatectomy has become more widespread and generally accepted over the last decade, opinions on modality of minimally invasive approach (robotic or laparoscopic) remain mixed with few institutions performing a significant portion of both operative approaches simultaneously.

Methods

247 minimally invasive left pancreatectomies were retrospectively identified in a prospectively maintained institutional REDCap™ database, 135 laparoscopic left pancreatectomy (LLP) and 108 robotic-assisted left pancreatectomy (RLP). Demographics, intraoperative variables, postoperative outcomes, and OR costs were compared between LLP and RLP with an additional subgroup analysis for procedures performed specifically for pancreatic adenocarcinoma (35 LLP and 23 RLP) focusing on pathologic outcomes and 2-year actuarial survival.

Results

There were no significant differences in preoperative demographics or indications between LLP and RLP with 34% performed for chronic pancreatitis and 23% performed for pancreatic adenocarcinoma. While laparoscopic cases were faster (p < 0.001) robotic cases had a higher rate of splenic preservation (p < 0.001). Median length of stay was 5 days for RLP and LLP, and rate of clinically significant grade B/C pancreatic fistula was approximately 20% for both groups. Conversion rates to laparotomy were 4.3% and 1.8% for LLP and RLP approaches respectively. RLP had a higher rate of readmission (p = 0.035). Pathologic outcomes and 2-year actuarial survival were similar between LLP and RLP. LLP on average saved $206.67 in OR costs over RLP.

Conclusions

This study demonstrates that at a high-volume center with significant minimally invasive experience, both LLP and RLP can be equally effective when used at the discretion of the operating surgeon. We view the laparoscopic and robotic platforms as tools for the modern surgeon, and at our institution, given the technical success of both operative approaches, we will continue to encourage our surgeons to approach a difficult operation with their tool of choice.

Graphical abstract

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

Similar content being viewed by others

References

  1. Konstantinidis IT, Lewis A, Lee B et al (2017) Minimally invasive distal pancreatectomy: greatest benefit for the frail. Surg Endosc 31:5234–5240

    Article  PubMed  PubMed Central  Google Scholar 

  2. de Rooij T, van Hilst J, Boerma D et al (2016) Impact of a nationwide training program in minimally invasive distal pancreatectomy (LAELAPS). Ann Surg 264(5):754–762

    Article  PubMed  Google Scholar 

  3. Matsuoka L, Parekh D (2012) The minimally invasive approach to surgical management of pancreatic diseases. Gastroenterol Clin North Am 41(1):77–101

    Article  PubMed  Google Scholar 

  4. Boggi U, Napoli N, Costa F et al (2016) Robotic-assisted pancreatic resections. World J Surg 40(10):2497–2506

    Article  PubMed  Google Scholar 

  5. Plotkin A, Ceppa EP, Zarzaur BL, Kilbane EM, Riall TS, Pitt HA (2017) Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma. HPB 19(3):279–285

    Article  PubMed  Google Scholar 

  6. Selby LV, DeMatteo RP, Tholey RM et al (2017) Evolving application of minimally invasive cancer operations at a tertiary cancer center. J Surg Oncol 115(4):365–370

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ III (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258(4):554–559 (discussion 559–562)

    Article  PubMed  PubMed Central  Google Scholar 

  8. de Rooij T, Besselink MG, Shamali A et al (2016) Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer. HPB 18(2):170–176

    Article  PubMed  Google Scholar 

  9. Gavriilidis P, Lim C, Menahem B, Lahat E, Salloum C, Azoulay D (2016) Robotic versus laparoscopic distal pancreatectomy—the first meta-analysis. HPB 18(7):567–574

    Article  PubMed  PubMed Central  Google Scholar 

  10. Daouadi M, Zureikat AH, Zenati MS et al (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 257(1):128–132

    Article  PubMed  Google Scholar 

  11. Goh BK, Chan CY, Soh HL et al (2017) A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. Int J Med Robot 13(1):e1733

    Article  Google Scholar 

  12. Liu R, Liu Q, Zhao ZM, Tan XL, Gao YX, Zhao GD (2017) Robotic versus laparoscopic distal pancreatectomy: a propensity score-matched study. J Surg Oncol 116:461–469

    Article  PubMed  Google Scholar 

  13. Lee SY, Allen PJ, Sadot E et al (2015) Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg 220(1):18–27

    Article  PubMed  Google Scholar 

  14. Xourafas D, Ashley SW, Clancy TE (2017) Comparison of perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy: an analysis of 1815 patients from the ACS-NSQIP procedure-targeted pancreatectomy database. J Gastrointest Surg 21:1442–1452

    Article  PubMed  Google Scholar 

  15. Ielpo B, Duran H, Diaz E et al (2017) Robotic versus laparoscopic distal pancreatectomy: a comparative study of clinical outcomes and costs analysis. Int J Surg 48:300–304

    Article  PubMed  Google Scholar 

  16. Souche R, Herrero A, Bourel G et al (2018) Robotic versus laparoscopic distal pancreatectomy: a French prospective single-center experience and cost-effectiveness analysis. Surg Endosc 32:3562–3569

    Article  PubMed  Google Scholar 

  17. Gebauer F, Tachezy M, Vashist YK et al (2015) Resection margin clearance in pancreatic cancer after implementation of the Leeds Pathology Protocol (LEEPP): clinically relevant or just academic? World J Surg 39(2):493–499

    Article  PubMed  Google Scholar 

  18. Strasberg SM, Fields R (2012) Left-sided pancreatic cancer: distal pancreatectomy and its variants: radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection. Cancer J 18(6):562–570

    Article  PubMed  Google Scholar 

  19. Chen S, Zhan Q, Chen JZ et al (2015) Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc 29(12):3507–3518

    Article  PubMed  Google Scholar 

  20. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

    Article  Google Scholar 

  21. Guerrini GP, Lauretta A, Belluco C et al (2017) Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg 17(1):105

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nassour I, Wang SC, Porembka MR et al (2017) Conversion of minimally invasive distal pancreatectomy: predictors and outcomes. Ann Surg Oncol 24(12):3725–3731

    Article  PubMed  Google Scholar 

  23. Wright GP, Zureikat AH (2016) Development of minimally invasive pancreatic surgery: an evidence-based systematic review of laparoscopic versus robotic approaches. J Gastrointest Surg 20(9):1658–1665

    Article  PubMed  Google Scholar 

  24. Zureikat AH, Borrebach J, Pitt HA et al (2017) Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. HPB 19(7):595–602

    Article  PubMed  Google Scholar 

  25. Hanna EM, Rozario N, Rupp C, Sindram D, Iannitti DA, Martinie JB (2013) Robotic hepatobiliary and pancreatic surgery: lessons learned and predictors for conversion. Int J Med Robot 9(2):152–159

    Article  PubMed  Google Scholar 

  26. Adam MA, Thomas S, Youngwirth L, Pappas T, Roman SA, Sosa JA (2017) Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg 152(4):336–342

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    William B. Lyman, Michael Passeri, Amit Sastry, Allyson Cochran, David A. Iannitti, Dionisios Vrochides, Erin H. Baker & John B. Martinie

Authors
  1. William B. Lyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Passeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Sastry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allyson Cochran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David A. Iannitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dionisios Vrochides
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erin H. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John B. Martinie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William B. Lyman.

Ethics declarations

Disclosures

Dr. Lyman reports grants from Intuitive Surgical, outside the submitted work. Dr. Iannitti reports personal fees from Ethicon, grants and personal fees from Medtronic, outside the submitted work. Dr. Vrochides reports personal fees from Ethicon, grants from Intuitive Surgical, outside the submitted work. Dr. Martinie reports grants and personal fees from Intuitive Surgical, personal fees from Ethicon, personal fees from Medtronic, outside the submitted work. Dr. Passeri, Dr. Sastry, Dr. Baker, and Ms. Cochran have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lyman, W.B., Passeri, M., Sastry, A. et al. Robotic-assisted versus laparoscopic left pancreatectomy at a high-volume, minimally invasive center. Surg Endosc 33, 2991–3000 (2019). https://doi.org/10.1007/s00464-018-6565-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6565-6

Keywords

Search

Navigation