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Indications, technique, and results of robotic pancreatoduodenectomy

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Abstract

Robotic assistance improves surgical dexterity in minimally invasive operations, especially when fine dissection and multiple sutures are required. As such, robotic assistance could be rewarding in the setting of robotic pancreatoduodenectomy (RPD). RPD was implemented at a high volume center with preemptive experience in advanced laparoscopy. Indications, surgical technique, and results of RPD are discussed against the background of current literature. RPD was performed in 112 consecutive patients. Conversion to open surgery was required in three patients, despite nine required segmental resection and reconstruction of the superior mesenteric/portal vein. No patient was converted to laparoscopy. A pancreato-jejunostomy was created in 106 patients (94.6 %), using either a duct-to-mucosa (n = 82; 73.2 %) or an invaginating (n = 24; 21.4 %) technique. Pancreato-gastrostomy was performed in one patient, the pancreatic duct was occluded in two patients, and a pancreatico-cutaneous fistula was created in three patients. Mean operative time was 526.3 ± 102.4 in the entire cohort and reduced significantly over the course of time. Experience was also associated with reduced rates of delayed gastric emptying and increased proportion of malignant tumor histology. Ninety day mortality was 3.6 %. Postoperative complications occurred in 83 patients (74.1 %) with a median comprehensive complication index of 20.9 (0–30.8). Clinically relevant pancreatic fistula occurred in 19.6 % of the patients. No grade C pancreatic fistula was noted in the last 72 consecutive patients. RPD is safely feasible in selected patients. Implementation of RPD requires sound experience with open pancreatoduodenectomy and advanced laparoscopic procedures, as well as specific training with the robotic platform.

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Authors and Affiliations

  1. Division of General and Transplant Surgery, University of Pisa, Pisa, Italy

    Niccolò Napoli, Emanuele F. Kauffmann, Francesca Menonna, Vittorio Grazio Perrone & Ugo Boggi

  2. Pietro Valdoni Department of Surgery, University of Rome La Sapienza, Rome, Italy

    Stefania Brozzetti

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  1. Niccolò Napoli
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  2. Emanuele F. Kauffmann
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  3. Francesca Menonna
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Correspondence to Ugo Boggi.

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All procedures analyzed in this study were conducted in accordance with the ethical standards of our Institution, and with the 1964 Helsinki declaration and its later amendments.

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Napoli, N., Kauffmann, E.F., Menonna, F. et al. Indications, technique, and results of robotic pancreatoduodenectomy. Updates Surg 68, 295–305 (2016). https://doi.org/10.1007/s13304-016-0387-7

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