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Technical Detail for Robot Assisted Pancreaticoduodenectomy
Published on: September 28, 2019
Minimally invasive pancreaticoduodenectomy: A comprehensive review
Mingjun Wang1, He Cai1, Lingwei Meng1
1Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China.
Background:
While an increasing number of open procedures are now routinely performed laparoscopically or robotically, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging operations in abdomen. The aim of this study is to evaluate the current status and development of MIPD.
Methods:
Embase, Medline, and PubMed databases were searched to identify studies up to and including Feb 2016 using the keywords "laparoscopic", or "laparoscopy", or "hand-assisted", or "minimally invasive", or "robotic", or "da vinci" combined with "pancreaticoduodenectomy", or "duodenopancreatectomy", "Whipple", or "pancreatic resection". Articles written in English with more than 10 cases were included for review.
Results:
Thirty-two articles representing 2209 patients were included for review. The weighted average operative time and intraoperative blood loss was 427.3 min and 289.4 mL respectively. A total of 375 patients required conversion to open pancreaticoduodenectomy (OPD), with an overall conversion rate of 17.8%. The postoperative severe complications (the Clavien-Dindo Classification ≥ III) occurred in 3.8%-33.0% patients, with an overall severe morbidity of 14.3%. Particularly, the overall incidence of clinically significant postoperative pancreatic fistula (POPF) was 8.0%. There were 26 perioperative death cases in total, with an overall postoperative mortality rate of 2.3%. The weighted average number of collected lymph nodes was 17.9, and R0 resection ranged from 60.0% to 100.0%. Comparisons between MIPD and OPD showed that MIPD increased operative time, decreased intraoperative blood loss and shortened the length of hospital stay, but the overall morbidity and mortality were comparable.
Conclusions:
MIPD is technically feasible and safe in highly selected patients and can offer acceptable oncological outcomes. But concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) is a challenging but feasible procedure. While it offers reduced blood loss and shorter hospital stays compared to open surgery, further research on long-term outcomes is needed.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) is a complex surgical procedure.
- While many abdominal surgeries are now performed with minimally invasive techniques, MIPD remains challenging.
- This study evaluates the current status and development of MIPD.
Purpose of the Study:
- To evaluate the current status and development of minimally invasive pancreaticoduodenectomy (MIPD).
Main Methods:
- A systematic review of Embase, Medline, and PubMed databases was conducted.
- Studies published up to February 2016 using keywords related to minimally invasive surgery and pancreaticoduodenectomy were included.
- Articles in English with over 10 cases were selected for review.
Main Results:
- 32 articles including 2209 patients were reviewed.
- MIPD showed a conversion rate of 17.8% to open surgery.
- Postoperative severe complications occurred in 14.3% of patients, with a 2.3% mortality rate. Clinically significant pancreatic fistula rate was 8.0%.
- MIPD decreased operative time, reduced intraoperative blood loss, and shortened hospital stays compared to open pancreaticoduodenectomy (OPD), with comparable overall morbidity and mortality.
Conclusions:
- Minimally invasive pancreaticoduodenectomy (MIPD) is technically feasible and safe for select patients, offering acceptable oncological outcomes.
- Further demonstration of long-term outcomes, cost-effectiveness, and learning curve is necessary before widespread adoption.
- MIPD presents a viable alternative to open surgery for pancreaticoduodenectomy in carefully selected cases.
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