Fully Robotic Whipple vs Open: Early Experience

Alejandro Mejia, MD, Jose R Soto, Stephen S Cheng, MD, Carlos Fasola, MD, Tarek Kahn, Richard Dickerman, MD. Methodist Dallas Medical Center

Minimally Invasive whipple has been offered at selective centers with results comparable to the open technique.Adoption of robotic surgery in HPB is still limited and viewed with skepticism.In this study, the early results of operative outcomes are compared for open (OW) and robotic whipples (RW) at a single HPB practice.

Methods:After the completion of robotic training in July 2013, every consecutive whipple case was compared for both techniques at a single practice until September 2014.RW were performed using the DaVinci Si system.A prospectively maintained database was analyzed for OR and patient variables.

Results: A total of 14 RW and 12 OW were performed in the study period.Clinical variables are shown in Table 1.Complications in the RW group include 2 conversions to open due to bleeding,one postop fluid collection requiring drainage and one cirrhotic patient who developed ascitis which was controlled with diuretics.No mortality has been observed in either group.

RW (n=14) OW (n=12) P
Age 67.3 +/- 8 62 +/- 10 NS
G(M/F) 10/4 7/5 NS
BMI 27 +/- 5 27.2 +/- 5 NS
LOS(days) 6.5 +/- 3.6 9.3 +/- 5.9 NS(0.14)
Transfusion 4 5 NS
OR time (min) 434 +/- 111 234 +/- 75 <0.001
Complications 4 4 NS

Conclusion: RW has been successfully introduced at a single HPB practice.Patients undergoing RW demonstrated shorter LOS which was not statistically significant but clinically significant.Despite longer OR times the RW had comparable outcomes to the OW .OR times have progressively decreased as the learning curve improves to comparable published times for larger series.Further studies are needed to compare costs and oncologic survival in the RW patients.

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