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Clinical Evidence – Pancreatectomy

The following selected publications support the clinical efficacy of da Vinci® General Surgery for distal pancreatectomy.

Please note: While Medline provides links to publishers' sites offering PDFs/full text articles, downloads typically require a fee. You may also contact academic libraries (for example, University of California) for document delivery services.

Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single surgeon experience. Surg Endosc 21 Nov 2009, DOI 10.1007/s00464-009-0825-4.

Abstract
Background: Use of robotic surgery has gained increasing acceptance over the last few years. There are few reports, however, on advanced pancreatic robotic surgery. In fact, the indication for robotic surgery in pancreatic disease has been controversial. This paper retrospectively reviews one surgeon's experience with robotic surgery to treat pancreatic disease, and analyzes its indications and outcomes, as well as the controversy that exists. Methods: A retrospective review of the charts of all patients who underwent robotic surgery for pancreatic disease by a single surgeon at two different institutions was carried out. Results: From October 2000 to January 2009, 134 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 134 patients, 83 were female. The average age of all patients was 57 years (range 24-86 years). Mean operating room (OR) time was 331 min (75-660 min). There were 14 conversions to open surgery. Mean length of stay was 9.3 days (3-85 days). Length of stay for patients with no complications was 7.9 days (3-15 days). The postoperative morbidity rate was 26% and the mortality rate was 2.23% (three patients). Among the procedures performed were 60 pancreaticoduodenectomies, 23 spleen-preserving distal pancreatectomies, 23 splenopancreatectomies, 3 middle pancreatectomies, 1 total pancreatectomy, and 3 enucleations. Another 21 patients underwent different surgical procedures for treatment of acute and chronic pancreatitis. Two cases of pancreaticoduodenectomy were performed in outside institutions and are not included in this series. Conclusions: This is the largest series of robotic pancreatic surgery presented to date. Robotic surgery enables difficult technical maneuvers to be performed that facilitate the success of pancreatic minimally invasive surgery. The results in this series demonstrate that it is feasible and safe. Complication and mortality rates are comparable to those of open surgery but with the advantages of minimally invasive surgery. © 2010 Springer Science+Business Media, LLC.

Waters J, Canal D, Wiebke EA, et al. Robot distal pancreatectomy: Cost effective? Surgery DOI 10.1016/j.surg.2010.07.027.

Abstract
Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic distal pancreatectomies. We hypothesized that robotic distal pancreatectomy is cost-effective. METHODS: Between August 2008 and August 2009, 77 distal pancreatectomies were performed at a single academic medical center. A retrospective analysis of prospectively collected data on demographics, short-term outcomes, and direct cost was performed. RESULTS: Thirty-two open distal pancreatectomies, 28 laparoscopic distal pancreatectomies, and 17 robotic distal pancreatectomies were performed. Age, American Society of Anesthesia preoperative risk score, and specimen length were similar. Indications for laparoscopic distal pancreatectomies and robotic distal pancreatectomies included more cystic neoplasms (49%) and fewer malignancies (29%) versus open distal pancreatectomies (16% and 47%). Spleen preservation occurred in 65% robotic distal pancreatectomies versus 12% and 29% in open distal pancreatectomies and laparoscopic distal pancreatectomies (P < .05). The operative time averaged 298 minutes in robotic distal pancreatectomies versus 245 and 222 minutes in open distal pancreatectomies and laparoscopic distal pancreatectomies (P < .05). Blood loss and morbidity were similar with no mortality. The length of stay was 4 days in robotic distal pancreatectomies versus 8 and 6 in open distal pancreatectomies and laparoscopic distal pancreatectomies (P < .05). The total cost was $10,588 in robotic distal pancreatectomies versus $16,059 and $12,986 in open distal pancreatectomies and laparoscopic distal pancreatectomies. CONCLUSION: These data suggest direct hospital costs are comparable among all groups. They suggest a shorter length of stay in robotic versus laparoscopic or open approaches. Finally, spleen and vessel preservation rates may improve with a robotic approach at the expense of increased operative time. In summary, robotic distal pancreatectomy is safe and cost effective in selected cases.

Horgan S, Galvani C, Gorodner V, et al.; Robotic distal pancreatectomy and nephrectomy for living donor pancreas-kidney transplantation; 2007 Transplantation, 84(7), pp. 934-936

Abstract
Living organ donation is of increasing importance to satisfy the demand of good quality organs for patients remaining for extended periods on the waiting list. While the benefit for the recipient is undeniable, the organ procurement represents an important burden to live donors in terms of invasiveness and long-term consequences. The latter can be minimized with careful donor selection. With the avenue of minimally invasive surgery, and more recently the availability of robotic technology, the surgical trauma can be reduced, the safety increased, and the recovery accelerated. In this case report, we present the first reported combined robotic distal pancreatectomy and left nephrectomy from a live donor. The surgery was performed using the Da Vinci robotic system with four small trocar incisions, and a short infraumbilical midline incision for hand-assistance and extraction of the organ. The donor operation lasted 5 hr and blood loss was only 100 mL. Both donor and recipient had an uncomplicated postoperative course and present with normal endocrine and renal function 3 mo after surgery. In experienced hands, advanced surgical procedures such as combined distal pancreatectomy and left nephrectomy can be safely performed in living donors with minimally invasive robotic surgery, dramatically reduced surgical trauma, and impressive postoperative recovery. The availability of minimally invasive robotic surgery may further increase the willingness for live organ donation from suitable donors.