Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

• DOI: 10.1007/s00464-022-09735-4
• Publication Date: 2022-11-18T22:03:04Z
• Authors: Anouk. M. L. H. E...; B. Görgec; M. J. W. Zwart; F. Daams; J. Erdmann; S. Festen; D. J. Gouma; T. M. van Gulik; J. van Hilst; G. Kazemier; S. Lof; S. I. Sussenbach; P. J. Tanis; B. M. Zonderhuis; O. R. Busch; R. J. Swijnenburg; M. G. Besselink
• Keywords: Invasive surgery

Many centers worldwide are shifting from laparoscopic to robotic minimally invasive hepato-pancreato-biliary resections (MIS-HPB) but large single center series assessing this process lacking. We hypothesized that the introduction of robot-assisted surgery was safe and feasible in a high-volume center.Single center, post-hoc assessment prospectively collected data including all consecutive MIS-HPB (January 2010-February 2022). As December 2018, MIS pancreatoduodenectomy liver were robot-assisted. All surgeons had participated dedicated training programs for MIS-HPB. Primary outcomes in-hospital/30-day mortality Clavien-Dindo ≥ 3 complications.Among 1875 pancreatic resections, 600 (32%) resections. The overall rate conversion 4.3%, complications 25.7%, 1.8% (n = 11). When comparing period before after (Dec 2018), use increased 25.3 43.8% (P < 0.001) blood loss decreased 250 ml [IQR 100-500] 150 50-300] 0.001). 291 included 163 pancreatoduodenectomies (52 laparoscopic, 111 robotic) with 4.3% rate. implementation associated reduced operation time (450 vs 361 min; P 0.001), (350 200 ml; delayed gastric emptying (28.8% 9.9%; 0.009). 309 198 procedures 3.6% resection less (24.7% 10.8%; 0.003) shorter hospital stay (4 days; 0.001).The greater up nearly half Although major morbidity not affected, improvements some selected outcomes. Ultimately, randomized studies high-quality registries should determine its added value.