Aim: During left-side speen-preserving pancreatectomy (SPLP), limitations of laparoscopy may require spleen sacrifice or conversion to maintain patient safety. The objective of our study is to compare short-term outcomes of robotic and pure laparoscopic SPLP in patients with benign or borderline lesions of the body/tail of pancreas in attempt to elucidate their risk and benefits in this setting. Materials and Methods: This is a Institutional Review Board case-matched study. Fifteen robotic SPLP (R-SPLP) were matched to 15 pure laparoscopic SPLP (L-SPLP). The peri-operative variables (conversion rate, amount of bleeding, operation time, length of hospital stay, complications, mortality and re-admission) were compared between the two groups, as well as the spleen preservation rate. Results: No R-SPLP was converted to conventional laparoscopy, hand-assisted laparoscopy or open surgery whereas L-SPLP had a conversion rate of 13,3% (p=NS). Fistula formation (20% vs. 46%; p=NS) and blood loss (189 vs. 200 ml; p=NS) were similar between the two groups. Mean operative time (220 vs. 279 min; p=0.027) and the spleen-preserving rate (fail/success, 0/15 vs. 4/11; p=0.03) of R-SPLP were considerably superior to that of the L-SPLP. Moreover, length of hospital stay was statistically shorter in R-SPLP group compared to L-SPLP (6,5 vs. 8,3 days; p=0.04). No mortality, need of blood transfusion or repeated surgery were observed in our series. Post-operative surgical complications occurred only in one L-SPLP patient (0% vs. 6,6%; p=NS) in which a fluid collection was drained by percutaneous catheter drainage. Conclusions: The Da Vinci endowrist instruments and specific device (PK™) allow the sealing of all individual small tributary splenic vessels or suturing during left pancreatectomy. This could provide an increased chance for spleen preservation, reduction of blood loss and faster surgical procedure. Furthermore, the fistula formation and the conversion rate seems to be lower, reducing contextually the hospitalization. Our study have confirmed the superiority of robotic assistance in SPLP but further study with
ROBOTIC-ASSISTED SPLEEN-PRESERVING LEFT PANCREATECTOMY: A CASE-MATCHED COMPARISON WITH PURE LAPAROSCOPIC TECHNIQUE
GUADAGNI, SIMONE;MORELLI, LUCA;DI FRANCO, GREGORIO;PALMERI, MATTEO;D'ISIDORO, CRISTIANO;PISANO, ROBERTA;PIETRABISSA, ANDREA;DI CANDIO, GIULIO;MOSCA, FRANCO
2015-01-01
Abstract
Aim: During left-side speen-preserving pancreatectomy (SPLP), limitations of laparoscopy may require spleen sacrifice or conversion to maintain patient safety. The objective of our study is to compare short-term outcomes of robotic and pure laparoscopic SPLP in patients with benign or borderline lesions of the body/tail of pancreas in attempt to elucidate their risk and benefits in this setting. Materials and Methods: This is a Institutional Review Board case-matched study. Fifteen robotic SPLP (R-SPLP) were matched to 15 pure laparoscopic SPLP (L-SPLP). The peri-operative variables (conversion rate, amount of bleeding, operation time, length of hospital stay, complications, mortality and re-admission) were compared between the two groups, as well as the spleen preservation rate. Results: No R-SPLP was converted to conventional laparoscopy, hand-assisted laparoscopy or open surgery whereas L-SPLP had a conversion rate of 13,3% (p=NS). Fistula formation (20% vs. 46%; p=NS) and blood loss (189 vs. 200 ml; p=NS) were similar between the two groups. Mean operative time (220 vs. 279 min; p=0.027) and the spleen-preserving rate (fail/success, 0/15 vs. 4/11; p=0.03) of R-SPLP were considerably superior to that of the L-SPLP. Moreover, length of hospital stay was statistically shorter in R-SPLP group compared to L-SPLP (6,5 vs. 8,3 days; p=0.04). No mortality, need of blood transfusion or repeated surgery were observed in our series. Post-operative surgical complications occurred only in one L-SPLP patient (0% vs. 6,6%; p=NS) in which a fluid collection was drained by percutaneous catheter drainage. Conclusions: The Da Vinci endowrist instruments and specific device (PK™) allow the sealing of all individual small tributary splenic vessels or suturing during left pancreatectomy. This could provide an increased chance for spleen preservation, reduction of blood loss and faster surgical procedure. Furthermore, the fistula formation and the conversion rate seems to be lower, reducing contextually the hospitalization. Our study have confirmed the superiority of robotic assistance in SPLP but further study withI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
