Recent advance in robotic pancreatic surgery

Minimally invasive surgery (MIS) with smaller wounds and less pain has become a worldwide trend in many surgical fields, including pancreatic surgeries. Pancreatic surgery, especially Pancreaticoduodenectomy, is a technique-demanding and time-consuming complex procedure, which used to be performed only by traditional open method. Traditional open pancreaticoduodenectomy (OPD) always needs a large abdominal incision, which would cause severe pain and also result in cosmetic problem. Recently, several limitations using laparoscopic approach have been overcome by da Vinci Robotic Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Several advantages including favorable ergonomics, articulation of instruments with 540° of motion, elimination of surgeon tremor, and a high-quality 3-dimensional vision with 10-15 magnification view, robotic approach can facilitate a more delicate and complex procedure such as pancreaticoduodenectomy which is involved in extensive dissection and restoration of the digestive tract continuity for the pancreas, bile duct, and stomach.
In this presentation, we will share with you our experience of robotic surgery in pancreas. The topics will include 1. from RDP to RPD; 2. RDP (Robotic distal pancreatectomy); 3.RPD (Robotic pancreaticoduodenectomy); 4. RTP (Robotic total pancreatectomy); 5. RCP (Robotic central pancreatectomy); 6. RSPDDP (Robotic Simultaneous PD and DP); 7.RE (Robotic Enucleation).
Based on our studies, LDP is comparable to RDP in regard to surgical outcomes. LDP with spleen-preservation is highly recommended whenever possible and feasible for benign or low malignant lesions in terms of lower costs and less blood loss. RCP could be recommended as a feasible and safe MIS alternative without compromising the surgical outcomes and pancreatic functions. RPD did not increas the surgical risks and, moreover, might provide benefits of less blood loss, less delayed gastric emptying, lower wound infection rate and shorter length of postoperative stay, as compared with OPD. Survival outcome for pancreatic head adenocarcinoma was better in RPD group. At least, RPD seems not to compromise the survival outcomes. Therefore, RPD is not only justified but also feasible in the treatment of periampullary lesions.