Robotic General Surgery

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CHAPTER 21 • Pancreaticoduodenectomy

7. Nota CL, Woo Y, Raoof M, et al. Robotic versus open minor liver resections of the posterosuperior segments: a multinational, propen sity score-matched study. Ann Surg Oncol . 2019;26(2):583-590. 8. Cai J, Ramanathan R, Zenati MS, et al. Robotic pancreaticoduo denectomy is associated with decreased clinically relevant pancre atic fistulas: a propensity-matched analysis. J Gastrointest Surg . 2020;24(5):1111-1118. 9. Shyr BU, Shyr BS, Chen SC, Shyr YM, Wang SE. Robotic and open pancreaticoduodenectomy: results from Taipei veterans general hos pital in Taiwan. Updates Surg . 2021;73(3):939-946. 10. Aziz H, Khan M, Khan S, et al. Assessing the perioperative compli cations and outcomes of robotic pancreaticoduodenectomy using the National Cancer Database: is it ready for prime time? J Robot Surg . 2022;16(3):687-694. 11. Fu Y, Qiu J, Yu Y, Wu D, Zhang T. Meta-analysis of robotic versus open pancreaticoduodenectomy in all patients and pancreatic cancer patients. Front Surg . 2022;9:989065. 12. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduo denectomy. Surg Endosc . 1994;8(5):408-410. 13. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancre aticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg . 2014;260(4):633-638. discussion 638-640. 14. Nickel F, Haney CM, Kowalewski KF, et al. Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg . 2020;271(1):54-66. 15. van Hilst J, de Rooij T, Bosscha K, et al; Dutch Pancreatic Cancer Group. Laparoscopic versus open pancreatoduodenectomy for pan creatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol . 2019;4(3):199-207. 16. Nassour I, Choti MA, Porembka MR, Yopp AC, Wang SC, Polanco PM. Robotic-assisted versus laparoscopic pancreaticoduodenectomy: oncological outcomes. Surg Endosc . 2018;32(6):2907-2913. 17. Xourafas D, Pawlik TM, Cloyd JM. Independent predictors of increased operative time and hospital length of stay are consistent across different surgical approaches to pancreatoduodenectomy. J Gastrointest Surg . 2018;22(11):1911-1919. 18. Van Oosten AF, Ding D, Habib JR, et al. Perioperative outcomes of robotic pancreaticoduodenectomy: a propensity-matched analysis to open and laparoscopic pancreaticoduodenectomy. J Gastrointest Surg . 2021;25(7):1795-1804. 19. Ouyang L, Zhang J, Feng Q, Zhang Z, Ma H, Zhang G. Robotic versus laparoscopic pancreaticoduodenectomy: an up-to-date system review and meta-analysis. Front Oncol . 2022;12:834382. 20. de Rooij T, van Hilst J, Boerma D, et al; Dutch Pancreatic Cancer Group. Impact of a nationwide training program in minimally inva sive distal pancreatectomy (LAELAPS). Ann Surg . 2016;264(5): 754-762. 21. Zwart MJW, Nota CLM, de Rooij T, et al; Dutch Pancreatic Cancer Group. Outcomes of a multicenter training program in robotic pancre atoduodenectomy (LAELAPS-3). Ann Surg . 2022;276(6):e886-e895. 22. Asbun HJ, Moekotte AL, Vissers FL, et al; International Study Group on Minimally Invasive Pancreas Surgery I-MIPS. The Miami International evidence-based guidelines on minimally invasive pan creas resection. Ann Surg . 2020;271(1):1-14. 23. Nota CL, Molenaar IQ, Te Riele WW, van Santvoort HC, Hagendoorn J, Borel Rinkes IHM. Stepwise implementation of robotic surgery in a high volume HPB practice in the Netherlands. HPB (Oxford) . 2020;22(11):1596-1603. 24. Hogg ME, Besselink MG, Clavien PA, et al; Minimally Invasive Pancreatic Resection Organizing Committee. Training in minimally invasive pancreatic resections: a paradigm shift away from “See one, do one, Teach one”. HPB (Oxford) . 2017;19(3):234-245. 25. Nota CLMA, Hagendoorn J, Borel Rinkes IHM, et al. Robotgeassisteerde Whipple-operatie. [Robot-assisted Whipple resec tion; results of the first 100 procedures in the Netherlands]. Article in Dutch. Ned Tijdschr Geneeskd . 2019;163:D3682. 26. Levi Sandri GB, Abu Hilal M, Dokmak S, et al; for the E-AHPBA Innovation & Development Committee. Figures do matter: a lit erature review on 4,587 robotic pancreatic resections and their implications on training. J Hepatobiliary Pancreat Sci . 2022;30(1): 21-35.

FUTURE AND CONCLUSIONS The use of a surgical robot enables a safe, minimally inva sive approach to PD. Potential patient benefits include less blood loss and an enhanced recovery after surgery. Compared with the current gold standard, the open approach, surgical and oncologic outcomes appear to be at least comparable, although randomized data are not avail able to date. Further implementation of minimally invasive pancreaticoduodenectomy is more likely through robotic surgery than conventional laparoscopically, since the latter technique is limited by rigid instruments and a two-dimen sional view. Moreover, safety concerns exist and wide spread implementation has lagged behind the past decades. REFERENCES 1. Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB (Oxford) . 2011;13(6):377-384. 2. Crist DW, Cameron JL. The current status of the Whipple operation for periampullary carcinoma. Adv Surg . 1992;25:21-49. 3. de Wilde RF, Besselink MG, van der Tweel I, et al; Dutch Pancreatic Cancer Group. Impact of nationwide centralization of pancreaticodu odenectomy on hospital mortality. Br J Surg . 2012;99(3):404-410. 4. Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general sur gery: personal experience in a large community hospital. Arch Surg . 2003;138(7):777-784. 5. Schwarz JL, Hogg ME. Current state of minimally invasive pancreatic surgery. J Surg Oncol . 2021;123(6):1370-1386. 6. Nota CL, Zwart MJ, Fong Y, et al; Dutch Pancreatic Cancer Group. Developing a robotic pancreas program: the Dutch experience. J Vis Surg . 2017;3:106. FIGURE 21.10 Construction of duodenojejunostomy or gastrojejunos tomy. An anticolic end-to-side gastrojejunostomy is preferred. (Ahmad SA, Wilson GC, Patel SH. Pancreaticoduodenectomy and total pan createctomy for cancer. In: Ellison EC, Upchurch GR, eds. Fischer’s Mastery of Surgery , 8th ed. Wolters Kluwer; 2024:1723-1749.)

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