Initiation of a robotic pancreatoduodenectomy program using virtual collaboration

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Robotic pancreatoduodenectomy (RPD) adoption is increasing, but challenges exist in safely implementing new programs, particularly regarding expert proctoring.
• A structured framework utilizing virtual collaboration was developed to overcome these limitations and facilitate the introduction of RPD.

Purpose of the Study:

• To describe the development and implementation of a structured approach for the safe introduction of a robotic pancreatoduodenectomy (RPD) program.
• To evaluate the feasibility and early outcomes of this novel RPD program facilitated by virtual expert collaboration.

Main Methods:

• A structured framework was designed, encompassing training, resource identification, team establishment, and patient safety protocols.
• Virtual collaboration with remote operative guidance from an expert proctor was employed for real-time support.
• Perioperative data and outcomes were collected from an initial cohort of 68 patients undergoing RPD.

Main Results:

• The initial cohort of 68 patients demonstrated favorable outcomes, with a median operative time of 407 minutes and estimated blood loss of 150 mL.
• A median length of stay of 8 days was observed, with 90% of resections achieving negative margins.
• Significant improvements were noted in the latter half of cases, including reduced operative time (380 vs. 441 minutes) and a lower conversion rate (6% vs. 21%).

Conclusions:

• The safe initiation of a structured robotic pancreatoduodenectomy program is achievable through virtual expert collaboration.
• Excellent perioperative outcomes can be attained even in the initial phase of program implementation with careful planning and execution.