Sharona Ross
University of Central Florida, USA
Title: Development of proficiency with robotic pancreaticoduodenectomy
Biography
Biography: Sharona Ross
Abstract
Introduction: As minimally invasive surgery continues to progress; robotic surgery is finding its application for complex abdominal operations. This study was undertaken to document our continued development of proficiency with robotic pancreaticoduodenectomy (PD).
Methodology: With IRB (Institutional Review Board) approval, the first 128 patients undergoing attempted robotic PD (pancreaticoduodenectomy) at a single institution have been prospectively followed. Patient demographics and outcomes were analyzed. Clavien scores of I-IIIb are defined as minimal severity. Operative duration was defined as time from incision to dressing application. Data are presented as median (mean±SD).
Results: 61% of patients were men, of age 69 (68±10.9) years, BMI 26 (27±7.5) kg/m2, and ASA class 3 (3±0.6). 77% of patients were diagnosed with adenocarcinoma. 21% of attempted robotic PD were converted to ‘open’ operations; operations converted to 'open' decreased with time (p<0.05, Figure). Operative duration (424 (425±113.6) minutes) did not change over time. 62% of resections were R0 and 38% of resections were initially R1 that were converted to R0. EBL (estimated blood loss) decreased with time, was minimal in patients undergoing robotic PD, and was greater in patients converted to ‘open’ PD (p<0.05). LOS (Length of stay) was longer for operations converted to ‘open’ PD (8 (12±13.1) days] than those completed robotically (5 (8±8.7) days, p<0.05]. Postoperative complications and in-hospital mortality were lower in operations completed robotically (p<0.05). Overall, 49% of patients experienced postoperative complications (e.g., infection, urinary retention, respiratory insufficiency) the majority of which, 78%, were of minimal severity. Of the procedures completed robotically, 45% of patients experienced postoperative complications with 85% of minimal severity.
Conclusions: Experience with robotic PD led to fewer conversions to ‘open’ and less EBL, but not shorter operative times. Operations converted to ‘open’ had a greater EBL, more postoperative complications, and longer LOS. By 128 attempted robotic pancreaticoduodenectomy, there was notable progress in the standardization of operative conduct; however, there remains room for further improvement. Our experience indicates robotic pancreaticoduodenectomy is practical and efficacious, but with longer operative duration and a notable learning curve.