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.
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.
Authors: Claudio Bassi; Giovanni Marchegiani; Christos Dervenis; Micheal Sarr; Mohammad Abu Hilal; Mustapha Adham; Peter Allen; Roland Andersson; Horacio J Asbun; Marc G Besselink; Kevin Conlon; Marco Del Chiaro; Massimo Falconi; Laureano Fernandez-Cruz; Carlos Fernandez-Del Castillo; Abe Fingerhut; Helmut Friess; Dirk J Gouma; Thilo Hackert; Jakob Izbicki; Keith D Lillemoe; John P Neoptolemos; Attila Olah; Richard Schulick; Shailesh V Shrikhande; Tadahiro Takada; Kyoichi Takaori; William Traverso; Charles R Vollmer; Christopher L Wolfgang; Charles J Yeo; Roberto Salvia; Marcus Buchler Journal: Surgery Date: 2016-12-28 Impact factor: 3.982
Authors: Amer H Zureikat; Jeffrey Borrebach; Henry A Pitt; Douglas Mcgill; Melissa E Hogg; Vanessa Thompson; David J Bentrem; Bruce L Hall; Herbert J Zeh Journal: HPB (Oxford) Date: 2017-04-08 Impact factor: 3.647
Authors: Florian Gebauer; Michael Tachezy; Yogesh K Vashist; Andreas H Marx; Emre Yekebas; Jakob R Izbicki; Maximilian Bockhorn Journal: World J Surg Date: 2015-02 Impact factor: 3.352
Authors: Ser Yee Lee; Peter J Allen; Eran Sadot; Michael I D'Angelica; Ronald P DeMatteo; Yuman Fong; William R Jarnagin; T Peter Kingham Journal: J Am Coll Surg Date: 2014-10-15 Impact factor: 6.113
Authors: Erin M Hanna; Nigel Rozario; Christopher Rupp; David Sindram; David A Iannitti; John B Martinie Journal: Int J Med Robot Date: 2013-03-19 Impact factor: 2.547
Authors: Pasquale Scognamiglio; Björn-Ole Stüben; Asmus Heumann; Jun Li; Jakob R Izbicki; Daniel Perez; Matthias Reeh Journal: Visc Med Date: 2021-11-12
Authors: Shi Qing Lee; Tousif Kabir; Ye-Xin Koh; Jin-Yao Teo; Ser-Yee Lee; Juinn-Huar Kam; Peng-Chung Cheow; Prema Raj Jeyaraj; Pierce K H Chow; London L Ooi; Alexander Y F Chung; Chung-Yip Chan; Brian K P Goh Journal: Ann Hepatobiliary Pancreat Surg Date: 2020-08-31
Authors: Christian Benzing; Lea Timmermann; Thomas Winklmann; Lena Marie Haiden; Karl Herbert Hillebrandt; Axel Winter; Max Magnus Maurer; Matthäus Felsenstein; Felix Krenzien; Moritz Schmelzle; Johann Pratschke; Thomas Malinka Journal: Langenbecks Arch Surg Date: 2022-03-21 Impact factor: 2.895