Kenneth Meredith, MD, FACS1, Ravi Shridhar, MD, PhD2, Jamie Huston, MS1, Mokenge Malafa, MD3, Pedro Briceno, MD1. 1Florida State University, Sarasota Memorial Health Care System, 2University of Central Florida, 3Moffitt Cancer Center
Introduction: Robotic assisted surgery allows for resection and reconstruction of complex abdominal procedures. We report our series with application of this technology to major pancreatic resections. Methods and Procedures: A retrospective review of a prospective robotic database was performed from 2012-2016. Peri-operative outcomes were analyzed. Chi-square or Fisher’s exact test was used to compare categorical variables as appropriate and Wilcoxon rank-sum test was used for non-normally distributed variables. P-values <0.05 were considered significant.
Results: We identified 116 patients who underwent major robotic pancreatic procedures: pancreaticoduodenctomies (RPD=71), distal pancreatectomies (RDP=32), total pancreatectomies (RTP=6), enucleations (RE=6), and cyst gastrostomy (RCG=1) with a median age of 71 (24-92) and BMI of 27.2 (18.4-39.9). There were no mortalities among the study population. Mean length of operation for the 2 most common procedures was 466±162 minutes for RPD and 268±95 minutes for RDP. Operative times improved over the course of the experience for RPD p<0.01. Conversion to open was required in 6 (5.2%) patients, (4 (5.6%) in the RPD, 1 (16.7%) RTP and 1 (3.1%) conversion to hand assist in the RDP). We compared robotic outcomes with pancreatic resection to a historical cohort of laparoscopic pancreatic resections in which the conversion rate was 24.6% p<0.001. The median estimated blood loss was 150 overall and 175 ml for RPD, 50 ml RDP, 275 ml RTP and 25 ml RE. R0 resections were performed in 114 (98.2%) patients and the median lymph node harvest was 18 (2-31) RPD, 13 (2-27) RDP, and 27 (14-37) RTP. The ISGPF grade C fistula was 2 (1.7%)%. Rate of Clavien 3 and 4 complications was 15 (12.9%) and 3(2.6%). The median length of hospitalization for the RPD was 7 (5-34) days and 5 (2-19) for the RDP. Readmissions were required in 19 (16.5%).
Conclusions: Robotic approaches to pancreatic resections are safe with excellent operative and oncologic outcomes. LOR steadily decreases as does post operative morbidity as the surgeon experience increases. The conversion to an open approach is lower then those who undergo laparoscopic approaches.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79857
Program Number: P681
Presentation Session: Poster (Non CME)
Presentation Type: Poster