Early experience with robotic pancreatic surgery

Sabrina Piedimonte, MSc, Yifan Wang, Tsafrir Vanounou, MD, MBA, Simon Bergman, MD, MSc

Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Canada

INTRODUCTION – Robotic technology may allow surgeons to offer patients with pancreatic pathology the benefits of minimally invasive surgery, without compromising the technical aspects of the procedure or patient safety. The purpose of this study was to describe our institution’s early experience with robotic pancreatic surgery and determine the safety of this approach during the initial phase of our institutional learning curve.

METHODS AND PROCEDURES –This is a retrospective descriptive case series of all patients who underwent robotic-assisted distal pancreatectomy or robotic-assisted pancreaticoduodenectomy from July 2010 to June 2012. Distal pancreatectomies were performed purely robotically. For the pancreaticoduodenectomies, the resection and gastrojejunostomy were performed laparoscopically and the pancreatic and biliary anastomoses were performed robotically. Demographic, early oncologic, and intraoperative data were collected. The primary outcome was 30-day complications and secondary outcomes were 90-day mortality, narcotic use, and length of hospital stay.

RESULTS – In the distal pancreatectomy group (n=3), the median operative time was 331 minutes (range 261-692), estimated blood loss was 600 cc (range 0-3000), and one patient had a positive margin. A median of 10 (range 0-37) lymph nodes were harvested. During hospitalization, the mean total analgesic use was 119.53± 25.7 mg equivalents of IV morphine. The median length of hospital stay was 6.5 days (range 4-14). One patient developed a wound infection and two patients developed grade B pancreatic leaks. All three complications progressed to intra-abdominal abscesses, that required readmission for percutaneous drainage. In the pancreaticoduodenectomy group (n=4), patients had a median operative time of 698 minutes (range 639-799), estimated blood loss of 300 cc (range 300-500) and one patient had a positive margin. The median number of harvested lymph nodes was 27 (range 18-44). Patients were hospitalized for a median of 8 days (range 6-8) and required a mean of 110.45 ± 15.89 mg equivalents of IV morphine. One patient had a pancreatic leak which resolved spontaneously (grade A). The other two patients developed gastroparesis post-discharge and were subsequently readmitted. There were no reoperations or mortalities within 90 days in either group.

CONCLUSION – Robotic-assisted pancreatic surgery is safe, with morbidity and mortality comparable to historical open data, even at the beginning of the institutional learning curve. Future efforts should be focused on refining peri-operative management protocols, as well as evaluating the long-term oncologic outcomes of robotic pancreatic surgery.

Session: Poster Presentation

Program Number: P633