Robotic Pancreatic Surgery: A Single Institution Experience

The overall activity of robotic pancreatic surgery at Misericordia Hospital in Grosseto has been reviewed. From October 2000 to March 2007, has been performed 68 robotic pancreatic resections: 35 pancreatoduodenectomies (PD) (25Whipple, 10 Longmire procedures), 28distal pancreatectomies (DP) (13 spleen-preserving), 3 middle segment pancreatectomies and 2 insulinoma enucleations.
The etiology of 35 PD were:11 ductal cancer, 9 ampullary carcinoma, 3 duodenal cancer, 7 mucinous cystadenoma, 4 chronic pancreatitis, 1 cystic dysplasia.
The mean operative time of robotic PD was 398 min. (range 240-480) and the average of intraoperative blood losses was 120 ml (range 50-300). No intraoperative transfusion needed. The conversion rate was 25.7% (9/35).
The overall morbidity rate was 31.4%. The mortality rate was 5.7% (2/35) (1 Boerhave’s syndrome, 1 colonic infarction).
The etiology of 28 DP were: 5 ductal cancer, 4 endocrine tumors, 2 cystadenocarcinoma, 11 mucinous cystadenoma, 1 insulinoma, 5 other pathologies. In 13/28 a spleen preserving DP was planned and successfully performed.
The mean op. time was 233 min. (range 120-390). The conversion rate was 3.5% (1/28).The average of blood loss was 80 ml (range 50-120). One case required an intraoperative blood transfusion. The overall morbidity rate was 14.2% (4/28: 4 low output pancreatic fistulas). The mortality rate was 0%.
A ductal cancer was diagnosed in 16/68 patients (11 PD and 5 DP). The TNM staging for PD was: T3N0M0 in 5, T3N1M0 in 3, T2N1M0 in 2 and T3N1M1 in 1; in the 5 cases of DP was: T3N1M0 in 3 and T3N0M0 in 2.
The overall mean survival rate for PD was 16.4 months.
3 patients (27.3%) are disease free with a median follow-up of 27.4 months. The overall mean survival rate of the 5 pts who underwent a DP was 17 months, and 3 patients (60%) are disease free with a median follow-up of 21.5 months. The most interesting data concern the reduction of intraoperative blood losses and the high percentage of spleen preservation in DP.
The cancer free survival seems to compare favourably with that of open surgery.

Session: Podium Presentation

Program Number: S071

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