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Open Access 01-06-2021 | Pancreatoduodenostomy | Review Article

State of the art of robotic pancreatoduodenectomy

Authors: Niccolò Napoli, Emanuele F. Kauffmann, Fabio Vistoli, Gabriella Amorese, Ugo Boggi

Published in: Updates in Surgery | Issue 3/2021

Abstract

Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic pancreatoduodenectomy (LPD). However, major intraoperative bleeding can occur and emergency conversion to OPD may be required. RPD reduces the risk of emergency conversion when compared to LPD. The learning curve of RPD ranges from 20 to 40 procedures, but proficiency is reached only after 250 operations. Once proficiency is achieved, the results of RPD may be superior to those of OPD. As for now, RPD is at least equivalent to OPD and LPD with respect to incidence and severity of POPF, incidence and severity of post-operative complications, and post-operative mortality. A minimal annual number of 20 procedures per center is recommended. In pancreatic cancer (versus OPD), RPD is associated with similar rates of R0 resections, but higher number of examined lymph nodes, lower blood loss, and lower need of blood transfusions. Multivariable analysis shows that RPD could improve patient survival. Data from selected centers show that vein resection and reconstruction is feasible during RPD, but at the price of high conversion rates and frequent use of small tangential resections. The true Achilles heel of RPD is higher operative costs that limit wider implementation of the procedure and accumulation of a large experience at most single centers. In conclusion, when proficiency is achieved, RPD may be superior to OPD with respect to CR-POPF and oncologic outcomes. Achievement of proficiency requires commitment, dedication, and truly high volumes.

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Title: State of the art of robotic pancreatoduodenectomy
Authors: Niccolò Napoli
Emanuele F. Kauffmann
Fabio Vistoli
Gabriella Amorese
Ugo Boggi
Publication date: 01-06-2021
Publisher: Springer International Publishing
Keywords: Pancreatoduodenostomy
Pancreatoduodenostomy
Pancreatic Cancer
Pancreatic Cancer
Published in: Updates in Surgery / Issue 3/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01058-8

Keynote webinar | Spotlight on medication adherence

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State of the art of robotic pancreatoduodenectomy

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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