Single-centre comparison of robotic and open pancreatoduodenectomy: a propensity score-matched study
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and Other Interventional Techniques
Single‑centre comparison of robotic and open pancreatoduodenectomy: a propensity score‑matched study Lapo Bencini1 · Federica Tofani1 · Claudia Paolini1 · Carla Vaccaro1 · Paolo Checcacci1 · Mario Annecchiarico1 · Luca Moraldi1 · Marco Farsi2 · Simone Polvani3 · Andrea Coratti1 Received: 18 September 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Pancreatoduodenectomy for pancreatic head and periampullary cancers is still associated with high perioperative morbidity and mortality. The aim of this study was to compare the short-term outcomes of robot-assisted pancreatoduodenectomy (RAPD) and open pancreatoduodenectomy (OPD) performed in a high-volume centre. Methods A single-centre, prospective database was used to retrospectively compare the early outcomes of RAPD procedures to standard OPD procedures completed between January 2014 and December 2018. Of the 121 included patients, 78 underwent RAPD and 43 underwent OPD. After propensity score matching (PSM), 35 RAPD patients were matched with 35 OPD patients with similar preoperative characteristics. Results There were no statistically significant differences in most of the baseline demographics and perioperative outcomes in the two groups after PSM optimization with the exception of the operative time (530 min (RAPD) versus 335 min (OPD) post-match, p 40 LPD/OPD per year, > 150 LPDs performed), although it was underpowered to compare major morbidity [18]. A Spanish trial reported similar results [19]. In contrast, the third trial from the Netherlands (LEOPARD-2) was interrupted due to inferior results in the laparoscopic arm [20]. The intrinsic limitations of laparoscopy, such as nonarticulated instruments, a lack of depth perception and its use in confined spaces, are the main obstacles to safely approaching the challenge of pancreatic surgery. Conversely, in the last decade, robotic surgery has been introduced to improve the feasibility of minimally invasive challenging procedures, such as pancreatic surgery, with encouraging results. The first robotic-assisted PD (RAPD) was published in 2003 by Giulianotti and colleagues from a large community hospital [21]. Although the indication for robotic surgery in pancreatic disease is still controversial due to the lack of large oncological datasets, the preliminary experiences are encouraging [22]. Robotic surgery is expected to minimize the trauma created in the exposure and handling of tissues and may offer the opportunity to combine the advantages of both minimally invasive and open surgery. The main advantages of the robotic system are an optimal and ergonomic surgeon position, deeper and more stable high-definition 3D vision,
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Surgical Endoscopy
endo-wrist arm technology (articulation of the instruments with 7 degrees of freedom), motion scaling and tremor filtration. Despite these theoretical advantages, RAPD remains a very challenging operation; its use is reserved to specialized centres wi
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