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ORIGINAL ARTICLE  APPLICATIONS OF ROBOTICS IN GENERAL SURGERY 

Minerva Surgery 2021 April;76(2):138-45

DOI: 10.23736/S2724-5691.21.08435-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Robotic pancreatic surgery: minimally invasive approach to challenging operations

Lapo BENCINI , Irene URCIUOLI, Martina TRAFELI, Claudia PAOLINI, Luca MORALDI, Angela TRIBUZI, Sabrina PACCIANI, Andrea CORATTI

Division of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy



BACKGROUND: Pancreatic surgery is still associated with high perioperative morbidity and mortality. The purpose of this study was to present the short-term outcomes of robot-assisted pancreatic surgery, including pancreaticoduodenectomy (RAPD), distal pancreatectomy (RDP) with or without splenectomy, enucleation (REN), and atypical resection (RAR), for benign, borderline, and malignant lesions at a high-volume center.
METHODS: A single-center, prospective database was used to retrospectively analyze the early outcomes of robotic pancreatic procedures completed between 2014 and 2020. Out of 124 attempted operations, 3 patients received palliative robotic surgery (2.4%). Of the remaining 121, 14 (11.6%) were converted to open surgery. The robotic procedures included 107 patients: 56 underwent RAPD, 31 underwent RDP (28 with and 3 without splenectomy), 16 underwent REN, and 4 underwent RAR (2 central and 2 total pancreatectomies).
RESULTS: The preoperative baseline characteristics and comorbidities were consistent with those of a Western population. The overall incidence of complications was 43.9%, with the more severe (Clavien-Dindo III-IV) occurring after RAPD (19.6%). We collected 7 (13.1%) postoperative pancreatic fistulae after RAPD, 5 (16.1%) after RADP, and 2 (12.5%) after REN. The two central pancreatectomies developed a biochemical leak without sequelae. Three patients (2.8%) died within 90 days after surgery. Early refeeding was achieved in those who did not experience severe complications, while the median hospital stay was 8 days. The median number of harvested lymph nodes was 22, with non-R1 microscopic residual tumors found.
CONCLUSIONS: Robotic pancreatic surgery is a safe and oncologically adequate technique to manage benign and malignant diseases arising from the head, body, and tail of the pancreas.


KEY WORDS: Pancreas; Surgical procedures, operative; Robotic surgical procedures

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