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Total laparoscopic versus robotic-assisted laparoscopic pancreaticoduodenectomy: which one is better?
Munseok Choi1, Seoung Yoon Rho1, Sung Hyun Kim2,3
1Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea.
Background:
Minimally invasive pancreaticoduodenectomy (MIPD) is a challenging procedure. Laparoscopic pancreaticoduodenectomy (LPD) is feasible and safe. Since the development of robotic platforms, the number of reports on robot-assisted pancreatic surgery has increased. We compared the technical feasibility and safety between LPD and robot-assisted LPD (RALPD).
Methods:
From September 2012 to August 2020, 257 patients who underwent MIPD for periampullary tumors were enrolled. Of these, 207 underwent LPD and 50 underwent RALPD. We performed a 1:1 propensity score-matched (PSM) analysis and retrospectively analyzed the demographics and surgical outcomes.
Results:
After PSM analysis, no difference was noted in demographics. Operation times and estimated blood loss were similar, as was the incidence of complications (p > 0.05). In subgroup analysis in patients with soft pancreas with pancreatic duct ≤ 2 mm, no significant between-group difference was noted regarding short-term surgical outcomes, including clinically relevant POPF (CR-POPF) (p > 0.05). In multivariable analysis, the only soft pancreatic texture was a predictive factor (HR 3.887, 95% confidence interval 1.121-13.480, p = 0.032).
Conclusion:
RALPD and LPD are safe and effective for MIPD and can compensate each other to achieve the goal of minimally invasive surgery.
