Skip to main content
Erschienen in: World Journal of Surgery 12/2011

01.12.2011

Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution

verfasst von: Nicolas Christian Buchs, Pietro Addeo, Francesco Maria Bianco, Subhashini Ayloo, Enrico Benedetti, Pier Cristoforo Giulianotti

Erschienen in: World Journal of Surgery | Ausgabe 12/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures, and its application is poorly reported in the literature so far. To date, few data are available comparing a minimally invasive approach to open PD. The aim of the present study is to compare the robotic and open approaches for PD at a single institution.

Methods

Data from 83 consecutive PD procedures performed between January 2002 and May 2010 at a single institution were retrospectively reviewed. Patients were stratified into two groups: the open group (n = 39; 47%) and the robotic group (n = 44; 53%).

Results

Patients in the robotic group were statistically older (63 years of age versus 56 years; p = 0.04) and heavier (body mass index: 27.7 vs. 24.8; p = 0.01); and had a higher American Society of Anesthesiologists (ASA) score (2.5 vs. 2.15; p = 0.01) when compared to the open group. Indications for surgery were the same in both groups. The robotic group had a significantly shorter operative time (444 vs. 559 min; p = 0.0001), reduced blood loss (387 vs. 827 ml; p = 0.0001), and a higher number of lymph nodes harvested (16.8 vs. 11; p = 0.02) compared to the open group. There was no significant difference between the two groups in terms of complication rates, mortality rates, and hospital stay.

Conclusions

The authors present one of the first studies comparing open and robotic PD. While it is too early to draw definitive conclusions concerning the long-term outcomes, short-term results show a positive trend in favor of the robotic approach without compromising the oncological principles associated with the open approach.
Literatur
1.
Zurück zum Zitat Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410PubMedCrossRef Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410PubMedCrossRef
2.
Zurück zum Zitat Dulucq JL, Wintringer P, Mahajna A (2006) Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20:1045–1050PubMedCrossRef Dulucq JL, Wintringer P, Mahajna A (2006) Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20:1045–1050PubMedCrossRef
3.
Zurück zum Zitat Gagner M, Palermo M (2009) Laparoscopic Whipple procedure: review of the literature. J Hepatobiliary Pancreat Surg 16:726–730PubMedCrossRef Gagner M, Palermo M (2009) Laparoscopic Whipple procedure: review of the literature. J Hepatobiliary Pancreat Surg 16:726–730PubMedCrossRef
4.
Zurück zum Zitat Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg 1:20–25PubMedCrossRef Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg 1:20–25PubMedCrossRef
5.
Zurück zum Zitat Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145:19–23PubMedCrossRef Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145:19–23PubMedCrossRef
6.
Zurück zum Zitat Palanivelu C, Jani K, Senthilnathan P et al (2007) Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg 205:222–230PubMedCrossRef Palanivelu C, Jani K, Senthilnathan P et al (2007) Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg 205:222–230PubMedCrossRef
7.
Zurück zum Zitat Palanivelu C, Rajan PS, Rangarajan M et al (2009) Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 16:731–740PubMedCrossRef Palanivelu C, Rajan PS, Rangarajan M et al (2009) Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 16:731–740PubMedCrossRef
8.
Zurück zum Zitat Cho A, Yamamoto H, Nagata M et al (2009) Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 198:445–449PubMedCrossRef Cho A, Yamamoto H, Nagata M et al (2009) Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 198:445–449PubMedCrossRef
9.
Zurück zum Zitat Buchs NC, Addeo P, Bianco FM et al (2010) Safety of robotic general surgery in elderly patients. J Robotic Surg 4:91–98CrossRef Buchs NC, Addeo P, Bianco FM et al (2010) Safety of robotic general surgery in elderly patients. J Robotic Surg 4:91–98CrossRef
10.
Zurück zum Zitat Buchs NC, Addeo P, Bianco FM et al (2010) Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years: a comparative study. World J Surg 34:2109–2114PubMedCrossRef Buchs NC, Addeo P, Bianco FM et al (2010) Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years: a comparative study. World J Surg 34:2109–2114PubMedCrossRef
11.
Zurück zum Zitat Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784PubMedCrossRef Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784PubMedCrossRef
12.
Zurück zum Zitat Giulianotti PC, Sbrana F, Bianco FM et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657PubMedCrossRef Giulianotti PC, Sbrana F, Bianco FM et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657PubMedCrossRef
13.
Zurück zum Zitat Giulianotti PC, Coratti A, Sbrana F et al (2011) Robotic liver surgery: results for 70 resections. Surgery 149:29–39PubMedCrossRef Giulianotti PC, Coratti A, Sbrana F et al (2011) Robotic liver surgery: results for 70 resections. Surgery 149:29–39PubMedCrossRef
14.
Zurück zum Zitat Trede M, Schwall G, Saeger HD (1990) Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 211:447–458PubMedCrossRef Trede M, Schwall G, Saeger HD (1990) Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 211:447–458PubMedCrossRef
15.
Zurück zum Zitat Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–142PubMedCrossRef Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–142PubMedCrossRef
16.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef
17.
Zurück zum Zitat Darwin P, Goldberg E, Uradomo L (2010) Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks. Gastrointest Endosc 71:99–104PubMedCrossRef Darwin P, Goldberg E, Uradomo L (2010) Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks. Gastrointest Endosc 71:99–104PubMedCrossRef
18.
Zurück zum Zitat van Berge Henegouwen MI, van Gulik TM, DeWit LT et al (1997) Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg 185:373–379PubMed van Berge Henegouwen MI, van Gulik TM, DeWit LT et al (1997) Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg 185:373–379PubMed
19.
Zurück zum Zitat Zheng MH, Feng B, Lu AG et al (2006) Laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma of common bile duct: a case report and literature review. Med Sci Monit 12:CS57–CS60PubMed Zheng MH, Feng B, Lu AG et al (2006) Laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma of common bile duct: a case report and literature review. Med Sci Monit 12:CS57–CS60PubMed
20.
Zurück zum Zitat Bhatti I, Peacock O, Awan AK et al (2010) Lymph node ratio versus number of affected lymph nodes as predictors of survival for resected pancreatic adenocarcinoma. World J Surg 34:768–775PubMedCrossRef Bhatti I, Peacock O, Awan AK et al (2010) Lymph node ratio versus number of affected lymph nodes as predictors of survival for resected pancreatic adenocarcinoma. World J Surg 34:768–775PubMedCrossRef
21.
Zurück zum Zitat Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462PubMedCrossRef Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462PubMedCrossRef
22.
Zurück zum Zitat Kazanjian KK, Hines OJ, Duffy JP et al (2008) Improved survival following pancreaticoduodenectomy to treat adenocarcinoma of the pancreas: the influence of operative blood loss. Arch Surg 143:1166–1171PubMedCrossRef Kazanjian KK, Hines OJ, Duffy JP et al (2008) Improved survival following pancreaticoduodenectomy to treat adenocarcinoma of the pancreas: the influence of operative blood loss. Arch Surg 143:1166–1171PubMedCrossRef
23.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579PubMedCrossRef Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579PubMedCrossRef
24.
Zurück zum Zitat Kim MC, Heo GU, Jung GJ (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24:610–615PubMedCrossRef Kim MC, Heo GU, Jung GJ (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24:610–615PubMedCrossRef
25.
Zurück zum Zitat Pugliese R, Maggioni D, Sansonna F et al (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602PubMedCrossRef Pugliese R, Maggioni D, Sansonna F et al (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602PubMedCrossRef
26.
Zurück zum Zitat Pugliese R, Maggioni D, Sansonna F et al (2009) Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol 35:281–288PubMedCrossRef Pugliese R, Maggioni D, Sansonna F et al (2009) Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol 35:281–288PubMedCrossRef
27.
Zurück zum Zitat Finkelstein J, Eckersberger E, Sadri H et al (2010) Open versus laparoscopic versus robot-assisted laparoscopic prostatectomy: the European and US experience. Rev Urol 12:35–43PubMed Finkelstein J, Eckersberger E, Sadri H et al (2010) Open versus laparoscopic versus robot-assisted laparoscopic prostatectomy: the European and US experience. Rev Urol 12:35–43PubMed
28.
Zurück zum Zitat Hiki N, Shimizu N, Yamaguchi H et al (2006) Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 93:195–204PubMedCrossRef Hiki N, Shimizu N, Yamaguchi H et al (2006) Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 93:195–204PubMedCrossRef
29.
Zurück zum Zitat Tran K, Van Eijck C, Di Carlo V et al (2002) Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 236:422–428PubMedCrossRef Tran K, Van Eijck C, Di Carlo V et al (2002) Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg 236:422–428PubMedCrossRef
30.
Zurück zum Zitat Iranmanesh P, Morel P, Wagner OJ et al (2010) Set-up and docking of the da Vinci surgical system: prospective analysis of initial experience. Int J Med Robot 6:57–60PubMed Iranmanesh P, Morel P, Wagner OJ et al (2010) Set-up and docking of the da Vinci surgical system: prospective analysis of initial experience. Int J Med Robot 6:57–60PubMed
31.
Zurück zum Zitat Schmidt CM, Turrini O, Parikh P et al (2010) Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg 145:634–640PubMedCrossRef Schmidt CM, Turrini O, Parikh P et al (2010) Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg 145:634–640PubMedCrossRef
32.
Zurück zum Zitat Young J (2009) Understanding statistical analysis in the surgical literature: some key concepts. ANZ J Surg 79:398–403PubMedCrossRef Young J (2009) Understanding statistical analysis in the surgical literature: some key concepts. ANZ J Surg 79:398–403PubMedCrossRef
33.
Zurück zum Zitat Brunaud L, Ayav A, Zarnegar R et al (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144:995–1001PubMedCrossRef Brunaud L, Ayav A, Zarnegar R et al (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144:995–1001PubMedCrossRef
34.
Zurück zum Zitat deSouza AL, Prasad LM, Park JJ et al (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53:1000–1006PubMedCrossRef deSouza AL, Prasad LM, Park JJ et al (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53:1000–1006PubMedCrossRef
Metadaten
Titel
Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution
verfasst von
Nicolas Christian Buchs
Pietro Addeo
Francesco Maria Bianco
Subhashini Ayloo
Enrico Benedetti
Pier Cristoforo Giulianotti
Publikationsdatum
01.12.2011
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 12/2011
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-011-1276-3

Weitere Artikel der Ausgabe 12/2011

World Journal of Surgery 12/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.