Robotic ampullectomy: Technique and results.

Victor Maciel, MD. St. Vincent Hospital

Background: Ampullectomy is mostly performed for periampullary malignancies, however, some benign disease may benefit from ampullectomy too. Transduodenal ampullectomy requires a precise dissection and complex reconstruction. Our group has been performing robotic ampullectomies for sphincter of Oddi dyskinesia (SOD) since 2005 with good results. The introduction of robotic techniques to our practice opened the possibility of performing this technically challenging operation with a minimally invasive approach and the added benefit of articulating instruments which -we believe- result in a better intra-abdominal suturing. We studied all consecutive cases of robotic ampullectomies for SOD performed since 2005 to date (n=13). Demographics, intraoperative and postoperative complications, length of stay, blood loss and operative times were recorded. Our main goal was to discuss the robotic ampullectomy technique and to evaluate the early results of this operation.

Methods: We performed a retrospective review of all consecutive cases of robotic ampullectomy in our practice from 2005 to Sept 2014. All cases were performed for SOD patients that underwent more than 3 ERCPs without long lasting relief of symptoms. Age, sex, BMI, length of stay, blood loss, perioperative complications, operative times and improvement of symptoms were all recorded.

Results: We have performed 13 robotic ampullectomies to date. We included only benign disease processes. 13 ampullectomies were performed for SOD refractory to more conservative management. 12 patients were females and only one male. Mean age was 43.3 yrs (range 24-62, +/- 12.15). All patients had an ASA score of 2 or 3. Mean operative time was 6hrs 31minutes (range 4:51-9:30, SD+/-72.5 min). Mean estimated blood loss was 117ml (range 10-300, +/- SD 73.6). Length of stay was widely variable, with a median of 5 days. (range 2-69, SD +/- 17.2). Four patients developed perioperative complications. One patient developed pancreatitis leading to ARDS and death.

Conclusions: Transduodenal ampullectomy is a complex surgical procedure that requires precise dissection and reconstruction. Morbidity and mortality are inherently high for this procedure. Robotic ampullectomy is feasible and we believe it gives the benefit of a minimally invasive surgery without sacrificing technical safety. More study is required to delineate the indications, risks and benefits of robotic ampullectomy.