Ann Surg Treat Res.  2021 Jun;100(6):329-337. 10.4174/astr.2021.100.6.329.

Effectiveness and stability of robot-assisted anastomosis in minimally invasive pancreaticoduodenectomy

• Park SE
• Choi HJ
• You YK
• Hong TH

• KMID: 2516226
• DOI: http://doi.org/10.4174/astr.2021.100.6.329

Abstract

Purpose
Reconstruction using robotic assistance in pancreaticoduodenectomy (PD) was expected to be an effective means to overcome the limitations of laparoscopic surgery. To our knowledge, few comparative reports exist on the outcomes of totally laparoscopic PD (TLPD) and robot-assisted laparoscopic PD (RLPD). This retrospective study aimed to analyze the surgical results of TLPD and RLPD in a high-volume pancreatic center.
Methods
We analyzed the surgical results of consecutive patients who underwent a minimally invasive PD for malignant or benign periampullary lesions between January 2016 and May 2020. Forty-three TLPD patients and 49 RLPD patients were enrolled.
Results
There were no significant differences in the demographic characteristics between the 2 groups except for tumor size, which was significantly larger in the RLPD group than in the TLPD group (mean, 3.1 cm vs. 2.5 cm; P = 0.035). The RLPD group had shorter whole operative times (mean, 400.4 minutes vs. 352.2 minutes; P = 0.003) and shorter anastomosis times than the TLPD group (mean, 94.5 minutes vs. 54.9 minutes; P < 0.001). There was no significant difference between the 2 groups in the rate of pancreatic fistulas, morbidity, and mortality. However, a significantly lower wound infection rate was found in the RLPD group relative to the TLPD group (0% vs. 9.3%, P = 0.038).
Conclusion
RLPD showed the advantage of reducing the operation time compared to TLPD as well as technical feasibility and safety.

Keyword

Laparoscopy; Pancreaticoduodenectomy; Robotics; Surgical anastomosis

Figure

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  Fig. 1 The pancreatic anastomosis method used. Pancreatic reconstruction was fundamentally performed by end-to-side, duct-to-mucosa anastomosis using several pancreas-penetrating sutures with an internal stent. (A) Four interrupted sutures (between trans-pancreas and sero-muscular layer of a jejunal wall). (B) Duct to mucosa suture. (C) Internal stent. (D) Tying the interrupted sutures.

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  Fig. 2 Docking of the surgical robotic system. Among the pre-used trocars for laparoscopic instruments during the resection stage (A), only 3 were replaced with the robot, including a trocar for the scope in the umbilicus and two 8-mm trocars at the right hypogastrium and subcostal location (B), without additional trocar insertion. Robotic reconstruction was performed by docking the robot arms at these 3 trocar sites.

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  Fig. 3 The multiple hepatic ducts encountered during the bilioenteric anastomosis. In the case of bilioenteric anastomosis, if several openings of the hepatic duct (white circle) are encountered when the proximal hepatic duct was resected to secure a cancer-free margin, anastomosis is not possible with simple laparoscopic tools. However, with the help of the robot, complex anastomosis could be successfully performed without conversion to open surgery.

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