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

• Published in: World journal of surgery 2011-12, Vol.35 (12), p.2739-2746
• Main Authors: Buchs, Nicolas Christian, Addeo, Pietro, Bianco, Francesco Maria, Ayloo, Subhashini, Benedetti, Enrico, Giulianotti, Pier Cristoforo
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Surgery; Female; General aspects; General Surgery; Humans; Intraductal Papillary Mucinous Neoplasm; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Open Group; Pancreatic Fistula; Pancreaticoduodenectomy - methods; Retrospective Studies; Robotic Approach; Robotic Group; Robotics; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracic Surgery; Vascular Surgery; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-011-1276-3

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.