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Is Robotic Pancreatic Surgery expected Access by the Minimal Access Pancreatic Surgeons?

Table 1: Total laparoscopic pancreaticoduodenectomies (NR: Nonreported)
Study Year Patients Mean Mean Mean Morbidity Mortality Conversion
operative estimated hospital cases cases cases
time (min) blood loss (ml) stay (days)
Gagner 12 1997 10 510 NR 22 3 NR 4
Dulucq 21 2006 16 287 107 16 4 1 3
Lu 22 2006 5 528 770 NR 2 1 1
Palanivelu 3 2007 75 357 74 8 20 1 0
Pugliese 23 2008 12 461 180 19 4 0 6
Kendrick 13 2010 54 368 240 7 26 1 0
Ammori 14 2011 6 628 350 11 2 0 0
Zureikat 24 2011 14 456 300 8 8 1 2
Total/mean 192 388.8 178.7 9.9 69 (35.9%) 5 (2.7%) 16 (8.3%)

Table 2: Total robotic pancreaticoduodenectomies (NR: Nonreported)
Study Year Patients Mean Mean Mean Morbidity Mortality Conversion
operative estimated hospital cases cases cases
time (min) blood loss (ml) stay (days)
Buchs 17 2010 41 430 389 13 16 1 2
Giulianotti (IT) 4 2010 36 312 261 22 NR 1 9
Giulianotti (USA) 4 2010 24 351 342 9 NR 1 2
Zhou 25 2011 8 718 153 16 2 0 0
Total/mean 109 394.77 319.06 15.31 18 (21%) 3 (3%) 13 (12%)

reported in RG with a good control in all of the cases in or medical necessity. In 16 patients (8.3%) of LG and in
both arms. 13 cases (12%) of RG the surgery was converted to an open
procedure.
Fistula

We do not use an specific international definition of DISCUSSION
postoperative pancreatic fistula (PPF) due to the varied
For many pancreatic disorders surgical resection offers the
definitions used by the differents authors, although most of
only chance for a cure, and surgery also plays a very
them adopted the international study group on pancreatic
important role in the symptom’s palliation of unresectable
fistula definition. Furthermore, to emphasize the difficulty
pancreatics neoplasms.
of the reconstruction, we joined all the anastomosis leaks
Since the first laparoscopic staging for pancreatic cancer
(pancreatic, biliary and digestive) in just one variable for
described by Dr Bernheim at the Johns Hopkins Hospital
the final analysis. The most common fistula reported was 5
in 1911, up to date, laparoscopic procedures for staging
PPF. We identified 28 cases (14.5%) from the LG and 33
with laparoscopic intraoperative ultrasonography seem to
(30%) in RG in which at least one total intracorporeal
be well accepted by the scientific community due to its
anastomosis presented a leak.
higher sensitivity for identifying intraabdominal metastasis
Mortality and facilitating biopsy and superior specificity for predicting
unresectability, compared with CT scan. 6-8
Operative mortality was defined as death within the period
of time from the surgery until the discharge. All the studies During the last 20 years many authors have reported
reported their mortality apart from one with 10 cases which large series of minimal access pancreatic surgery with
were not taken into account in the analysis. We found multiple procedures, from distal pancreatectomies with or
five patients (2.7%) who died during the hospital stay, most without splenic-preserving to pancreaticoduodenectomies
of them due to an advanced septicemia condition secondary (Whipple’s procedure or even pylorus-preserving PD),
to pancreatic fistula in LG. In the robotic arm, we identified including enucleations and central resections. In contrast
three patients (3%) who died, one of them secondary to to laparoscopic PD, laparoscopic distal pancreatectomies
esophageal rupture at 85 days after primary resection. 4 have been reported with increasing frequency. The main
reasons are the easier surgical technique of the procedure
Conversion without the need of an anastomosis and, of course, the

Conversion was understood as an impossibility to perform well-known advantages of laparoscopy in general. But,
the total laparoscopic approach, both technical difficulties minimal access PD is considered by many surgeons, most

World Journal of Laparoscopic Surgery, January-April 2012;5(1):49-53 51