Robotic-Assisted Pancreatoduodenectomy
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MINIMALLY INVASIVE PANCREATIC SURGERY (MG HOUSE, SECTION EDITOR)
Robotic-Assisted Pancreatoduodenectomy Mohammad Khreiss • Herbert J. Zeh Brian A. Boone • Amer H. Zureikat
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Published online: 14 March 2013 Springer Science + Business Media New York 2013
Abstract Pancreatoduodenectomy remains one of the most complex and technically challenging procedures of the upper gastrointestinal tract with a mortality rate of 5 % and morbidity of 40 %. In an attempt to refine the Whipple procedure and taking into consideration the success of minimally invasive surgery in other organ systems, some have popularized the laparoscopic pancreatoduodenectomy (LPD). However, laparoscopic surgery carries several limitations that can make the LPD difficult to implement. Use of the robotic platform offers multiple advantages that may allow robotic assisted pancreatoduodenctomy to be readily adopted. As the robotic platform becomes increasingly popular, this report will provide an up to date review on the robotic pancreatoduodenectomy. Keywords Robotic-assisted pancreatoduodenectomy Pancreatoduodenectomy Whipple Pancreatic cancer Laparoscopic pancreatoduodenectomy Pancreatic resection
Introduction First performed by Allen O. Whipple in 1935 [1], pancreatoduodenectomy for periampullary lesions remains one of the most complex and technically challenging procedures of the upper gastrointestinal tract, with a mortality of 5 % and a M. Khreiss B. A. Boone University of Pittsburgh Medical Center, Pittsburgh, PA, USA H. J. Zeh A. H. Zureikat (&) Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 421, UPMC Cancer Pavilion, Pittsburgh, PA 15232, USA e-mail: [email protected]
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morbidity of 40 % [2–5]. Short of the pylorus-preserving modification by Traverso and Longmire [6], the procedure has withstood the test of time since its advent. In an attempt to refine the Whipple procedure and taking into consideration the success of minimally invasive surgery in other organ systems with equal or superior outcomes [7–9], the first minimally invasive pancreatoduodenectomy (LPD) was described by Gagner and Pomp in 1994 [10]. Several series have been published since then that reported outcomes comparable to the open approach, but fell short of realizing any advantages. As a result, and due to potential benefits of the robotic platform, robotic-assisted pancreatoduodencetomy (RAPD) has been reported with increasing frequency. Here, we review the current outcomes of RAPD and LPD.
Robotic-Assisted Pancreatodoudenectomy (RAPD) Background Despite early reports of safety, laparoscopic surgery has not been widely adopted for complex pancreatic resection and reconstruction. Today, LPD is only being performed in highly specialized centers and by highly skilled laparoscopic surgeons. We believe this is because the laparoscopic platform may not be adequate for complex uncinate dissections nor allow the fine motor skills required for safe complex reconstruction. The technology itself with two-dimens
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