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Surgical Endoscopy

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01-03-2013

Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application

Authors: Ho Kyoung Hwang, Chang Moo Kang, Young Eun Chung, Kyung Ah Kim, Sung Hoon Choi, Woo Jung Lee

Published in: Surgical Endoscopy | Issue 3/2013

Abstract

Background

Advanced and delicate laparoscopic techniques are usually required for safe and successful laparoscopic spleen-preserving distal pancreatectomy. The unique characteristics of robotic surgical system are thought to be useful for this minimally invasive procedure.

Methods

From September 2007 to May 2011, patients who underwent robot-assisted, spleen-preserving, distal pancreatectomy for benign and borderline malignant tumors of the pancreas were retrospectively reviewed. Perioperative clinicopathologic surgical outcomes were evaluated.

Results

Twenty-two patients were attempted for robot-assisted, spleen-preserving, distal pancreatectomy, and in 21 patients (95.5 %), the spleen was saved either by splenic vessels conservation (SVC; n = 17, 81 %) or by splenic vessels sacrifice (SVS; n = 4, 19 %). Seven patients were male and 15 were female with a mean age of 43.2 ± 15.2 years. Pathologic diagnosis included MCT in five patients, SCT in five, SPT in four, IPMT in three, NET in three, and other benign conditions in two. The mean operation time was 398.9 ± 166.3 min, but it gradually decreased as experiences were accumulated (Rsq = 0.223, p = 0.023). Intraoperative blood loss was 361.3 ± 360.1 ml, and intraoperative transfusion was required in four patients (18.1 %). A soft diet was given for 1.2 ± 0.4 days, and the length of hospital stay was 7.0 ± 2.4 days postoperatively. Clinically relevant pancreatic fistula was noted in two patients (9.1 %) but was successfully managed conservatively. Most patients (87.5 %) showed patency in conserved both splenic vessels, and only two patients (12.5 %) had partially or completely obliterated in splenic veins in the SVC-SpDP group. Partially impaired splenic perfusion was observed in one patient in the SVS-SpDP group. The perfusion defect area decreased without any clinical symptom after 4 months.

Conclusions

The robotic surgical system is thought to be beneficial for improving the spleen-preservation rate in laparoscopic distal pancreatectomy. Robot-assisted approach can be chosen for patients who require spleen-preserving distal pancreatectomy.

Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park do H, Han DJ (2011) Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25:3364–3372PubMedCrossRef

Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137PubMedCrossRef

Yoon YS, Lee KH, Han HS, Cho JY, Ahn KS (2009) Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg 96:633–640PubMedCrossRef

Hwang HK, Chung YE, Kim KA, Kang CM, Lee WJ (2012) Revisiting vascular patency after spleen-preserving laparoscopic distal pancreatectomy with conservation of splenic vessels. Surg Endosc

Tien YW, Liu KL, Hu RH, Wang HP, Chang KJ, Lee PH (2010) Risk of varices bleeding after spleen-preserving distal pancreatectomy with excision of splenic artery and vein. Ann Surg Oncol 17:2193–2198PubMedCrossRef

Miura F, Takada T, Asano T, Kenmochi T, Ochiai T, Amano H, Yoshida M (2005) Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery 138:518–522PubMedCrossRef

Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268PubMedCrossRef

Palanivelu C, Shetty R, Jani K, Sendhilkumar K, Rajan PS, Maheshkumar GS (2007) Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center. Surg Endosc 21:373–377PubMedCrossRef

Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82PubMedCrossRef

10.

Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501PubMedCrossRef

11.

Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 19:1028–1034PubMedCrossRef

12.

Ballantyne GH (2007) Telerobotic gastrointestinal surgery: phase 2–safety and efficacy. Surg Endosc 21:1054–1062PubMedCrossRef

13.

Talamini MA, Chapman S, Horgan S, Melvin WS (2003) A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 17:1521–1524PubMedCrossRef

14.

Ballentyne GH MJ, Giulianotti PC (2004) Primer of robotic & telerobotic surgery. ch. 22: 155-164

15.

Kim DH, Kang CM, Lee WJ, Chi HS (2011) The first experience of robot assisted spleen-preserving laparoscopic distal pancreatectomy in Korea. Yonsei Med J 52:539–542PubMedCrossRef

16.

Kim DH, Kang CM, Lee WJ, Chi HS (2011) Robotic central pancreatectomy with pancreaticogastrostomy (transgastric approach) in a solid pseudopapillary tumor of the pancreas. Hepatogastroenterology 58:1805–1808PubMed

17.

Kang CM, Kim DH, Lee WJ, Chi HS (2011) Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 25:2004–2009PubMedCrossRef

18.

Kang CM, Kim DH, Lee WJ, Chi HS (2011) Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy. Surg Endosc 25:1101–1106PubMedCrossRef

19.

Choi SH, Kang CM, Hwang HK, Lee WJ, Chi HS (2012) Robotic Anterior RAMPS in Well-Selected Left-Sided Pancreatic Cancer. J Gastrointest Surg

20.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef

21.

Chung CT, Bogart JA, Adams JF, Sagerman RH, Numann PJ, Tassiopoulos A, Duggan DB (1997) Increased risk of breast cancer in splenectomized patients undergoing radiation therapy for Hodgkin’s disease. Int J Radiat Oncol Biol Phys 37:405–409PubMedCrossRef

22.

Schwarz RE, Harrison LE, Conlon KC, Klimstra DS, Brennan MF (1999) The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma. J Am Coll Surg 188:516–521PubMedCrossRef

23.

Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137:164–168PubMedCrossRef

24.

Guru KA, Hussain A, Chandrasekhar R, Piacente P, Bienko M, Glasgow M, Underwood W, Wilding G, Mohler JL, Menon M, Peabody JO (2009) Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons. Can J Urol 16:4736–4741 discussion 4741PubMed

25.

Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253:1060–1066PubMedCrossRef

26.

Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249:927–932PubMedCrossRef

27.

Baik SH, Lee WJ, Rha KH, Kim NK, Sohn SK, Chi HS, Cho CH, Lee SK, Cheon JH, Ahn JB, Kim WH (2008) Robotic total mesorectal excision for rectal cancer using four robotic arms. Surg Endosc 22:792–797PubMedCrossRef

28.

Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, Chung KY (2010) Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg 139(53–59):e51

29.

Miura F, Sano K, Amano H, Toyota N, Wada K, Kadowaki S, Shibuya M, Maeno S, Takada T, Hayano K, Matsubara H (2011) Is spleen-preserving distal pancreatectomy with excision of the splenic artery and vein feasible? Surgery 150:572PubMedCrossRef

30.

Warshaw AL (2010) Distal pancreatectomy with preservation of the spleen. J Hepatobiliary Pancreat Sci 17:808–812PubMedCrossRef

31.

Jones P, Leder K, Woolley I, Cameron P, Cheng A, Spelman D (2010) Postsplenectomy infection - strategies for prevention in general practice. Aust Fam Physician 39:383–386PubMed

32.

Kendrick ML, Sclabas GM (2011) Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford) 13:454–458CrossRef

33.

Zureikat AH, Breaux JA, Steel JL, Hughes SJ (2011) Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg 15:1151–1157PubMedCrossRef

34.

Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145:19–23PubMedCrossRef

35.

Benoist S, Dugue L, Sauvanet A, Valverde A, Mauvais F, Paye F, Farges O, Belghiti J (1999) Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 188:255–260PubMedCrossRef

36.

Waghorn DJ (2001) Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol 54:214–218PubMedCrossRef

37.

Jockovich M, Mendenhall NP, Sombeck MD, Talbert JL, Copeland EM 3rd, Bland KI (1994) Long-term complications of laparotomy in Hodgkin’s disease. Ann Surg 219:615–621 discussion 621-614PubMedCrossRef

38.

Di Sabatino A, Carsetti R, Corazza GR (2011) Post-splenectomy and hyposplenic states. Lancet 378:86–97PubMedCrossRef

Title: Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application
Authors: Ho Kyoung Hwang
Chang Moo Kang
Young Eun Chung
Kyung Ah Kim
Sung Hoon Choi
Woo Jung Lee
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 3/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2551-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon’s experiences and proposal of clinical application

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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