Robotic total pancreatectomy with splenectomy: technique and outcomes

Area of Science:

• Minimally invasive surgery
• Surgical oncology
• Robotic surgery

Background:

• Robotic total pancreatectomy (TP) is an evolving minimally invasive approach for major intra-abdominal operations.
• Its utility, technique, and outcomes are under continuous development.

Purpose of the Study:

• To describe a systematic approach to robotic TP for multifocal intraductal papillary mucinous neoplasm (IPMN).
• To compare outcomes of robotic TP versus laparoscopic and open TP using the National Cancer Database (NCDB).

Main Methods:

• A stepwise robotic TP technique using the da Vinci Xi system was performed and documented.
• The NCDB was reviewed for outcomes of 73 patients undergoing robotic, laparoscopic, or open TP between 2010 and 2014.

Main Results:

• Robotic TP involved a detailed 16-step procedure, including lymphadenectomy and reconstruction.
• NCDB analysis showed similar margin-negative resections and lymph node retrieval across all TP approaches.
• Robotic and laparoscopic TP were associated with shorter hospital stays and reduced 30/90-day mortality compared to open TP.
• Median survival for pancreatic adenocarcinoma patients was comparable among the three surgical approaches.

Conclusions:

• Robotic total pancreatectomy with splenectomy is a feasible and reproducible minimally invasive technique.
• This approach yields improved postoperative outcomes and equivalent oncologic results compared to open total pancreatectomy.