☆ 4.4 Article

Robotic spleen-preserving distal pancreatectomy: the Verona experience

UPDATES IN SURGERY (2021)

Journal

UPDATES IN SURGERY

Volume 73, Issue 3, Pages 923-928

Publisher

SPRINGER-VERLAG ITALIA SRL

DOI: 10.1007/s13304-020-00731-8

Keywords

Distal pancreatectomy; Robotic left pancreatectomy; Surgical technique

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Abstract

The study demonstrates the safety and feasibility of robotic spleen-preserving distal pancreatectomy in treating benign or pre-malignant pancreatic diseases. Surgical outcomes showed comparable morbidity with standard treatment and no mortality, suggesting RSPDP as a valid option for appropriate patients. Further research is needed to standardize the technique and assess its potential benefits.

Background The minimally invasive approach in spleen-preserving distal pancreatectomy has currently been emphasized in benign and pre-malignant pancreatic diseases. The study aims to demonstrate the safety and feasibility of our technique of robotic spleen-preserving distal pancreatectomy (RSPDP) by a stepwise approach. Methods The data of consecutive patients presented for RSPDP from 2014 to 2019 at Verona University were retrieved from a prospectively maintained database. The patients were divided into two groups based on the surgical procedure performed, such as Kimura's (KG) or Warshaw's (WG) technique, and then compared. Results In the study period, 32 patients underwent RSPDP. Twenty-three patients presented for the Kimura procedure (72%), while nine patients underwent the Warshaw procedure (28%). A higher body mass index was found in the KG (26 +/- 4 vs. 22 +/- 3,p = 0.037). Regarding the pathological data, the WG group differed in the tumor dimension, and the lymph nodes harvested (30 +/- 2 vs. 17 +/- 10, 9 +/- 5 vs. 3 +/- 4,p = 0.0028, andp = 0.005, respectively). Notably, no conversions and mortality were recorded. The overall morbidity was 25% ( eight patients) with no difference between the groups (p = 0.820). The mean length of stay was 8 days, and was similar between the groups (p = 0.350). Conclusions The present study suggests that RSPDP is a valid option for the treatment of benign or pre-malignant pancreatic diseases of the distal pancreas, with comparable morbidity with the standard treatment and no mortality. Further research is needed to standardize the technique and to assess the immunological, surgical, and financial benefits of the procedure.

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Identifying the preoperative factors predicting the surgical difficulty of robotic distal pancreatectomy

Qiang Xu, Pengyu Li, Hanyu Zhang, Mengyi Wang, Qiaofei Liu, Wenjing Liu, Menghua Dai

Summary: This study aimed to explore preoperative factors predicting the surgical difficulty of robotic distal pancreatectomy (RDP) and provide guidance on patient selection for surgeons lacking extensive experience. The study found that male sex, BMI>=25 kg/m2, tumor located at the neck of the pancreas, and splenic artery type B were independent risk factors for surgical difficulty.

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