Full robotic pancreatoduodenectomy with the da Vinci Xi: a single surgeon's experience with the first 40 consecutive cases without conversion
EAES Academy. Palmeri M. 07/05/22; 363137; P182
Dr. Matteo Palmeri
Contributions
Contributions
Abstract
Aims:
Robotic pancreatoduodenectomy (R-PD) has been demonstrated to be as feasible and safe as the open approach. Several studies have reported a learning curve for R-PD performed by a single surgeon that ranges from 20 to 40 cases, and a rate of conversion to open surgery that ranges from 1.1% to 5.1%. We report our experience with the first 40 consecutive R-PD performed by a single surgeon previously experienced in pancreatic surgery, and in robotic surgery for other indications.
Methods:
A retrospective study of the first 40 consecutive cases of R-PD performed by a single surgeon from May 2018 to December 2021 in our Institution was conducted to evaluate the perioperative outcomes. Patients with pancreatic and periampullary tumours without vascular involvement were included in this study, regardless of BMI or previous abdominal surgery.
Results:
Out of 40 patients undergoing R-PD, no one was converted to open surgery, despite 18 (45%) of them had undergone previous abdominal surgery, 14 (35%) had a BMI 25 kg/m2 and < 30 kg/m2 and 3 (7,5%) of them had a BMI 30 kg/m2. Mean operative time was 434,9 112,1 minutes while mean console time was 282,7 39,5 minutes. The median postoperative stay was 10 days [8-21,75], 15 out of 40 patients were discharged within POD 8. Five patients (12,5%) had major complications (Clavien-Dindo grade 3 or above), while only 2 (5%) clinically relevant (grade B both) POPFs were encountered. There was no 30-day mortality. A full-robotic technique, both for the resective phase and for the reconstructive phase, was performed in all patients.
Conclusions:
R-PD is a technically feasible and safe procedure for pancreatic and periampullary tumours. When an extensive previous experience in both pancreatic and robotic surgery is present, the da Vinci Xi platform allows to perform challenging procedures such as R-PD with a minimally invasive approach and low risk of conversion to open surgery, regardless of the learning curve specific for this procedure.
Robotic pancreatoduodenectomy (R-PD) has been demonstrated to be as feasible and safe as the open approach. Several studies have reported a learning curve for R-PD performed by a single surgeon that ranges from 20 to 40 cases, and a rate of conversion to open surgery that ranges from 1.1% to 5.1%. We report our experience with the first 40 consecutive R-PD performed by a single surgeon previously experienced in pancreatic surgery, and in robotic surgery for other indications.
Methods:
A retrospective study of the first 40 consecutive cases of R-PD performed by a single surgeon from May 2018 to December 2021 in our Institution was conducted to evaluate the perioperative outcomes. Patients with pancreatic and periampullary tumours without vascular involvement were included in this study, regardless of BMI or previous abdominal surgery.
Results:
Out of 40 patients undergoing R-PD, no one was converted to open surgery, despite 18 (45%) of them had undergone previous abdominal surgery, 14 (35%) had a BMI 25 kg/m2 and < 30 kg/m2 and 3 (7,5%) of them had a BMI 30 kg/m2. Mean operative time was 434,9 112,1 minutes while mean console time was 282,7 39,5 minutes. The median postoperative stay was 10 days [8-21,75], 15 out of 40 patients were discharged within POD 8. Five patients (12,5%) had major complications (Clavien-Dindo grade 3 or above), while only 2 (5%) clinically relevant (grade B both) POPFs were encountered. There was no 30-day mortality. A full-robotic technique, both for the resective phase and for the reconstructive phase, was performed in all patients.
Conclusions:
R-PD is a technically feasible and safe procedure for pancreatic and periampullary tumours. When an extensive previous experience in both pancreatic and robotic surgery is present, the da Vinci Xi platform allows to perform challenging procedures such as R-PD with a minimally invasive approach and low risk of conversion to open surgery, regardless of the learning curve specific for this procedure.
Aims:
Robotic pancreatoduodenectomy (R-PD) has been demonstrated to be as feasible and safe as the open approach. Several studies have reported a learning curve for R-PD performed by a single surgeon that ranges from 20 to 40 cases, and a rate of conversion to open surgery that ranges from 1.1% to 5.1%. We report our experience with the first 40 consecutive R-PD performed by a single surgeon previously experienced in pancreatic surgery, and in robotic surgery for other indications.
Methods:
A retrospective study of the first 40 consecutive cases of R-PD performed by a single surgeon from May 2018 to December 2021 in our Institution was conducted to evaluate the perioperative outcomes. Patients with pancreatic and periampullary tumours without vascular involvement were included in this study, regardless of BMI or previous abdominal surgery.
Results:
Out of 40 patients undergoing R-PD, no one was converted to open surgery, despite 18 (45%) of them had undergone previous abdominal surgery, 14 (35%) had a BMI 25 kg/m2 and < 30 kg/m2 and 3 (7,5%) of them had a BMI 30 kg/m2. Mean operative time was 434,9 112,1 minutes while mean console time was 282,7 39,5 minutes. The median postoperative stay was 10 days [8-21,75], 15 out of 40 patients were discharged within POD 8. Five patients (12,5%) had major complications (Clavien-Dindo grade 3 or above), while only 2 (5%) clinically relevant (grade B both) POPFs were encountered. There was no 30-day mortality. A full-robotic technique, both for the resective phase and for the reconstructive phase, was performed in all patients.
Conclusions:
R-PD is a technically feasible and safe procedure for pancreatic and periampullary tumours. When an extensive previous experience in both pancreatic and robotic surgery is present, the da Vinci Xi platform allows to perform challenging procedures such as R-PD with a minimally invasive approach and low risk of conversion to open surgery, regardless of the learning curve specific for this procedure.
Robotic pancreatoduodenectomy (R-PD) has been demonstrated to be as feasible and safe as the open approach. Several studies have reported a learning curve for R-PD performed by a single surgeon that ranges from 20 to 40 cases, and a rate of conversion to open surgery that ranges from 1.1% to 5.1%. We report our experience with the first 40 consecutive R-PD performed by a single surgeon previously experienced in pancreatic surgery, and in robotic surgery for other indications.
Methods:
A retrospective study of the first 40 consecutive cases of R-PD performed by a single surgeon from May 2018 to December 2021 in our Institution was conducted to evaluate the perioperative outcomes. Patients with pancreatic and periampullary tumours without vascular involvement were included in this study, regardless of BMI or previous abdominal surgery.
Results:
Out of 40 patients undergoing R-PD, no one was converted to open surgery, despite 18 (45%) of them had undergone previous abdominal surgery, 14 (35%) had a BMI 25 kg/m2 and < 30 kg/m2 and 3 (7,5%) of them had a BMI 30 kg/m2. Mean operative time was 434,9 112,1 minutes while mean console time was 282,7 39,5 minutes. The median postoperative stay was 10 days [8-21,75], 15 out of 40 patients were discharged within POD 8. Five patients (12,5%) had major complications (Clavien-Dindo grade 3 or above), while only 2 (5%) clinically relevant (grade B both) POPFs were encountered. There was no 30-day mortality. A full-robotic technique, both for the resective phase and for the reconstructive phase, was performed in all patients.
Conclusions:
R-PD is a technically feasible and safe procedure for pancreatic and periampullary tumours. When an extensive previous experience in both pancreatic and robotic surgery is present, the da Vinci Xi platform allows to perform challenging procedures such as R-PD with a minimally invasive approach and low risk of conversion to open surgery, regardless of the learning curve specific for this procedure.
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