Page 31 - World Association of Laparoscopic Surgeons - Journal
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B Srinivas
Table 2: Advantages and disadvantages of robot-assisted surgery vs conventional surgery
Human strengths Human limitations Robot strengths Robot limitations
Strong hand-eye Limited dexterity outside Good geometric accuracy No judgment
coordination natural scale
Dexterous Prone to tremor and fatigue Stable and untiring Unable to use qualitative
Flexible and adaptable Limited geometric accuracy information
Can integrate extensive and Limited ability to use Scale motion Absence of haptic sensation
diverse information quantitative information Can use diverse sensors Expensive
Rudimentary haptic abilities Limited sterility in control
Able to use qualitative Susceptible to radiation May be sterilized Technology in flux
information and infection Resistant to radiation and More studies needed
Good judgment infection
Easy to instruct and debrief
trials showed no difference in leakage and fistula rate Whether the current-generation surgical robot is
between pancreaticogastrostomy and pancreaticojejunos- advanced enough to allow routine performance of pancreatic
tomy. 21-23 The duct to mucosa technique was utilized for head tumor resections remains to be seen. In an operation
both pancreaticogastrostomy and hepaticojejunostomy. like the Whipple procedure, where we rely so heavily on
Such a technique showed low or at least the same rate of blind palpation for careful dissection of the portal vein off
leakage compared to the conventional method. 24,25 the posterior pancreatic surface, it is possible that the da
Two major concerns that anticipate early adoption of Vinci’s lack of haptic feedback may preclude its safe
laparoscopic Whipple comprised of the difficult surgical application. 28-30
technique, resulting in a long operative time, as well the
CONCLUSION
oncologic question about the adequacy of the laparoscopic
operation. 19,26 To shorten the learning curve of laparoscopic Robotic-assisted minimally invasive pancreaticoduodenec-
approach, the hand-assisted hybrid technique had been used tomy can be performed safely and effectively with
with favorable results Table 2. Recently, robotic Whipple significant individual and institutional preparation and
using the da Vinci system has also been shown to be feasible commitment. Safety is directly related to the surgical team’s
and efficient. 27 ability to complete the operative procedure in an open
All the benefits of minimally invasive surgery may be fashion, and a breadth of experience dealing with complex
expected from the robotic Whipple procedure. Patients interoperative hepatobiliary complications. If oncological
undergoing robotic procedure mobilize earlier than their principles and/or safety are compromised, the procedure
open counterparts. The median length of hospital stay is needs to be converted to a standard open Whipple. 10
6.2 days (range, 5.2-18.8), which compares favorably to The patient requires an upfront frank preoperative
open Whipple procedure,where the median length of discussion regarding the novel approach of the minimally
15
10
hospital stay is 7.9 days. One of the principal objections invasive pancreaticoduodenectomy. Informed consent can
to the robotic procedure is the increased duration of be obtained if the benefits, risks and the alternatives—an
operating time. The mean robotic operating time is 8 hours open procedure—are discussed in detail. The robotic team
(range 5.9-9.6), which again compares favorably open should consist of expert pancreas and skilled robotic
surgery where the mean operating time is 5.4 hours. 10 surgeons, nurses and operating room technicians. When the
The robotic Whipple needs to conform to the standards surgical team is motivated to push the frontiers of pancreas
that have been set and validated for an open Whipple. surgery, the patient will benefit from the minimally invasive
Modifications and/or shortcuts to allow for use of the robot procedure.
should be avoided if the robotic resection cannot be
REFERENCES
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