Page 3 - World Association of Laparoscopic Surgeons - Journal

WJOLS
10.5005/jp-journals-10007-1148
Is Robotic Pancreatic Surgery expected Access by the Minimal Access Pancreatic Surgeons?
REVIEW ARTICLE
Is Robotic Pancreatic Surgery expected Access
by the Minimal Access Pancreatic Surgeons?

RJ Orti-Rodríguez

ABSTRACT when the procedure is performed by experienced surgeons
in referral centers.
Objectives: Many surgeons have demonstrated the feasibility
of laparoscopic pancreatoduodenectomies (PD), but benefits At the same time, minimal access techniques are in a
comparable to or even more prominent than those of an open high-speed development day by day, minute by minute and
procedure has not been clinically proven. Robotic surgery has
second by second. Once a surgical technique is not fully
improved some aspects of the laparoscopic approach. We
demonstrated yet, another new access technique approach
compare both types of approach for PD.
or even instrument is born. In pancreatic surgery there is
Methods: The literature was systematically reviewed to find all
the PD procedures totally performed by a laparoscopic or by a increasing interest in the feasibility of minimal access
robotic approach. techniques in an attempt to decrease morbidity. But, the
difficulty of performing these complex resections and
Results: Between 1996 and 2012, 192 patients underwent a
total laparoscopic PD and 109 a total robotic PD. The mean reconstructions without the whole freedom of movement
operating room time and mean estimated blood loss was of the open surgery can cast doubt on the suitability of the
388.8 minutes and 178.7 ml for LG and 397.4 minutes and laparoscopic approach.
319.06 ml for RG. Morbidity was found in 18 cases of RG and in
Robotic surgery, an unstoppable field of the minimal
69 of LG. Mortality and conversion rates were similars in both
arms. access surgery, has improved some limitations of standard
laparoscopic surgery such, among other things, ergonomic,
Conclusion: This review can not find clear difference between
both groups in spite of the short literature available. precision suturing and of course tha lack of three-dimensional
visualization. So, is robotic surgery the step we were
Keywords: Laparoscopic, Robotic, Pancreatoduodenectomy,
Whipple. expecting for minimal access PD?
In this review, we present the current evidence available
How to cite this article: Orti-Rodríguez RJ. Is Robotic
on minimal access PD comparing both techniques to sort
Pancreatic Surgery expected Access by the Minimal Access
Pancreatic Surgeons? World J Lap Surg 2012;5(1):49-53. out this question.
Source of support: Nil
METHODS
Conflict of interest: None declared
Search Strategy
INTRODUCTION The PubMed database was searched electronically from
1996 up to January 2011 (inclusive). Search terms used
Even in unresectable pancreatic neoplasms, staging or included: Laparoscopic, robotic, Whipple procedure,
palliation can be accomplished by laparoscopic means. It is pancreaticoduodenectomy, pancreatoduodenectomy. Terms
well known that the morbidity of a large laparotomy, which
were searched both in isolation and in combination. Search
is required for an adequate exposure, can be avoided with limits were applied to include articles published in English
laparoscopic examination and ultrasonography for staging, or in Spanish languages and human studies only. Articles
laparoscopic palliative bypass surgery or thoracoscopic published in abstract form only, single case reports, review
splanchnicectomy for pain control. articles or reporting less than five cases were not included
But, what about minimal access pancreatic resection for for the final analysis. Cases describing hand assistance as
pancreatic cancer? Surgical resection in nonadvanced part of the procedure or hybrid approaches are also excluded
pancreatic neoplasms represents the only hope of cure. The in this study because were not considered as just one pure
definitive surgical procedure for carcinoma of the head of approach (total laparoscopic or total robotic PDs). For
the pancreas is the Whipple pancreaticoduodenectomy (PD), authors or institutions who republished their results with
and for some time now, pylorus-preserving PD is replacing larger series, only the most recent article and larger series
standard Whipple PD because a better gastric emptying may were included. To achieve a more homogeneous data
result in better nutrition and weight gain. Although debate collecting, series of patients from multicentric studies were
continues, the open approach continues to enjoy decreasing taken, when the information reported allowed, as
rates of morbidity and mortality around the world, of course, independent series according to the institution. Flow chart

World Journal of Laparoscopic Surgery, January-April 2012;5(1):49-53 49