Robotic and open pancreaticoduodenectomy: results from Taipei Veterans General Hospital in Taiwan
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ORIGINAL ARTICLE
Robotic and open pancreaticoduodenectomy: results from Taipei Veterans General Hospital in Taiwan Bor‑Uei Shyr1 · Bor‑Shiuan Shyr1 · Shih‑Chin Chen1 · Yi‑Ming Shyr1 · Shin‑E. Wang1 Received: 11 May 2020 / Accepted: 8 October 2020 © Italian Society of Surgery (SIC) 2020
Abstract This study is to clarify the feasibility and justification of robotic pancreaticoduodenectomy (RPD) by comparing the outcomes between RPD and open pancreaticoduodenectomy (OPD) groups. All perioperative data and outcomes were prospectively collected. There were 304 (63.9%) RPD and 172 (36.1%) OPD. The median operation time was longer in RPD group than OPD (7.5 vs 7.0 h). The blood loss was much lower in RPD group, with a median of 130 vs. 400 c.c. in OPD group. Based on Clavien–Dindo classification, grade 0 (no complication) was 51.8% in RPD group, higher than 43.2% in OPD. Delayed gastric emptying was only 3.5% in RPD group, much lower than 13.6% in OPD. Wound infection rate was also lower in RPD group, 3.2% vs. 7.7% in OPD. The postoperative hospital stay was shorter in RPD group, with a median of 20 days, vs. 24 days in OPD. There was no significant difference regarding the lymph node yield, surgical mortality, postoperative pancreatic fistula, postpancreatectomy hemorrhage, chyle leakage and bile leakage between RPD and OPD groups. For pancreatic head adenocarcinoma, the survival outcome was better in RPD group, with 1-year, 3-year, and 5-year survival of 82.9%, 45.3%, and 26.8% respectively, as compared with 63.8%, 26.2%, and 17.4% in OPD. RPD is not only feasible but also justified without increasing the surgical risks and compromising the survival outcomes. Moreover, RPD might provide benefits of less blood loss, less delayed gastric emptying, lower wound infection rate and shorter length of postoperative stay, as compared with OPD. Keywords Pancreaticoduodenectomy · Periampullary · Robotic · Open
Background Pancreaticoduodenectomy is a technique-demanding and time-consuming complex procedure, which used to be performed only by the traditional open method. Minimally invasive approach for this procedure has been attempted by some surgeons [1, 2]. Traditional open pancreaticoduodenectomy (OPD) always needs a large abdominal incision, which would cause severe pain and also result in a cosmetic problem. Minimally invasive surgery with smaller wounds and less pain has become a worldwide trend in many surgical fields, including pancreatic surgeries [3–5]. Recently, several Yi-Ming Shyr and Shin-E. Wang equally contribute to this paper. * Shin‑E. Wang [email protected] 1
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, 201 Section 2 Shipai Road, Taipei 112, Taiwan
limitations using a laparoscopic approach have been overcome by da Vinci Robotic Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) [3, 6]. Several advantages including favorable ergonomics, articulation of instruments with 540° of motion, elimination of surgeon tremor, a
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