Amer H Zureikat1, Joal D Beane2, Mazen S Zenati3, Amr I Al Abbas1, Brian A Boone4, A James Moser5, David L Bartlett1, Melissa E Hogg6, Herbert J Zeh7. 1. Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 2. The Ohio State University, Division of Surgical Oncology, Columbus, OH. 3. Division of General Surgery and Epidemiology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 4. Division of Surgical Oncology, Department of Surgery, West Virginia University, Morgantown, WV. 5. Institute for Hepatobiliary and Pancreatic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA. 6. Department of Surgery, NorthShore University Health System, Evanston, IL. 7. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Abstract
OBJECTIVES: This study aims to present the outcomes of our decade-long experience of robotic pancreatoduodenectomy and provide insights into successful program implementation. BACKGROUND: Despite significant improvement in mortality over the past 30 years, morbidity following open pancreatoduodenectomy remains high. We implemented a minimally invasive pancreatic surgery program based on the robotic platform as one potential method of improving outcomes for this operation. METHODS: A retrospective review of a prospectively maintained institutional database was performed to identify patients who underwent robotic pancreatoduodenectomy (RPD) between 2008 and 2017 at the University of Pittsburgh. RESULTS: In total, 500 consecutive RPDs were included. Operative time, conversion to open, blood loss, and clinically relevant postoperative pancreatic fistula improved early in the experience and have remained low despite increasing complexity of case selection as reflected by increasing number of patients with pancreatic cancer, vascular resections, and higher Charlson Comorbidity scores (all P<0.05). Operating room time plateaued after 240 cases at a median time of 391 minutes (interquartile rang 340-477). Major complications (Clavien >2) occurred in less than 24%, clinically relevant postoperative pancreatic fistula in 7.8%, 30- and 90-day mortality were 1.4% and 3.1% respectively, and median length of stay was 8 days. Outcomes were not impacted by integration of trainees or expansion of selection criteria. CONCLUSIONS: Structured implementation of robotic pancreatoduodenectomy can be associated with excellent outcomes. In the largest series of RPD, we establish benchmarks for the surgical community to consider when adopting this approach.
OBJECTIVES: This study aims to present the outcomes of our decade-long experience of robotic pancreatoduodenectomy and provide insights into successful program implementation. BACKGROUND: Despite significant improvement in mortality over the past 30 years, morbidity following open pancreatoduodenectomy remains high. We implemented a minimally invasive pancreatic surgery program based on the robotic platform as one potential method of improving outcomes for this operation. METHODS: A retrospective review of a prospectively maintained institutional database was performed to identify patients who underwent robotic pancreatoduodenectomy (RPD) between 2008 and 2017 at the University of Pittsburgh. RESULTS: In total, 500 consecutive RPDs were included. Operative time, conversion to open, blood loss, and clinically relevant postoperative pancreatic fistula improved early in the experience and have remained low despite increasing complexity of case selection as reflected by increasing number of patients with pancreatic cancer, vascular resections, and higher Charlson Comorbidity scores (all P<0.05). Operating room time plateaued after 240 cases at a median time of 391 minutes (interquartile rang 340-477). Major complications (Clavien >2) occurred in less than 24%, clinically relevant postoperative pancreatic fistula in 7.8%, 30- and 90-day mortality were 1.4% and 3.1% respectively, and median length of stay was 8 days. Outcomes were not impacted by integration of trainees or expansion of selection criteria. CONCLUSIONS: Structured implementation of robotic pancreatoduodenectomy can be associated with excellent outcomes. In the largest series of RPD, we establish benchmarks for the surgical community to consider when adopting this approach.
Authors: Melissa E Hogg; Mazen Zenati; Stephanie Novak; Yong Chen; Yan Jun; Jennifer Steve; Stacy J Kowalsky; David L Bartlett; Amer H Zureikat; Herbert J Zeh Journal: Ann Surg Date: 2016-09 Impact factor: 12.969
Authors: Moritz N Wente; Claudio Bassi; Christos Dervenis; Abe Fingerhut; Dirk J Gouma; Jakob R Izbicki; John P Neoptolemos; Robert T Padbury; Michael G Sarr; L William Traverso; Charles J Yeo; Markus W Büchler Journal: Surgery Date: 2007-11 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: Melissa E Hogg; Marc G Besselink; Pierre-Alain Clavien; Abe Fingerhut; D Rohan Jeyarajah; David A Kooby; A James Moser; Henry A Pitt; Oliver A Varban; Charles M Vollmer; Herbert J Zeh; Paul Hansen Journal: HPB (Oxford) Date: 2017-02-10 Impact factor: 3.647
Authors: Charles M Vollmer; Russell S Lewis; Bruce L Hall; John D Allendorf; Joal D Beane; Stephen W Behrman; Mark P Callery; John D Christein; Jeffrey A Drebin; Irene Epelboym; Jin He; Henry A Pitt; Emily Winslow; Christopher Wolfgang; Steven M Strasberg Journal: Ann Surg Date: 2015-03 Impact factor: 12.969
Authors: Matthew T McMillan; Amer H Zureikat; Melissa E Hogg; Stacy J Kowalsky; Herbert J Zeh; Michael H Sprys; Charles M Vollmer Journal: JAMA Surg Date: 2017-04-01 Impact factor: 14.766
Authors: Carl R Schmidt; Britney R Harris; Kelsey A Musgrove; Pavan Rao; J Wallis Marsh; Alan A Thomay; Melissa E Hogg; Herbert J Zeh; Amer H Zureikat; Brian A Boone Journal: J Surg Oncol Date: 2020-11-02 Impact factor: 3.454