June S Peng, MD, Trang K Nguyen, Hari B Keshava, Toms Augustin, Nelson A Royall, Sricharan Chalikonda. Cleveland Clinic
Introduction: There is a substantial learning curve to performing minimally invasive pancreatoduodenectomy (MIS-PD) for surgeons who are trained in open PD. The learning curve to transition from robotic assisted PD (RAPD) to total laparoscopic PD (TLPD) is not well established.
Methods: MIS-PDs performed between January 2014 and June 2017 performed by SC as a surgeon or co-surgeon were included for analysis. MIS-PDs were performed using a robotic assisted technique prior to August 2016, and TLPDs were performed subsequently. RAPDs performed prior to 2014 were excluded to limit the comparison to RAPDs after the initial learning curve. Demographics, clinical and pathologic outcomes, operative and post-operative outcomes were compared.
Results: A total of 28 RAPDs and 12 TLPDs were scheduled during the study period. There was no statistically significant difference in age, body mass index, or prior abdominal surgery. Median time from initial clinic consultation to surgery was 35 days for the RAPD group versus 15 days in the TLPD group (p = 0.005). Conversion to laparotomy was required in 4 of 28 patients (14.3%) in the RAPD group versus 2 of 12 patients (16.7%) in the TLPD group (p > 0.99).
For completed MIS-PDs, there were no statistically significant differences in the operative time (449 minutes for RAPD versus 416 minutes for TLPD, p = 0.22), adenocarcinoma on pathology (58.3% versus 60.0%, p > 0.99), tumor size (2.5 cm for both groups), or R0 margin (83.3% vs 100%, p = 0.30). There were small differences favoring TLPD for estimated blood loss (150 mL for RAPD versus 75 mL for TLPD, p < 0.001) and nodal harvest (15 versus 20 lymph nodes, p = 0.045). There was no difference in development of clinically relevant postoperative pancreatic fistula (20.8% versus 20.0%, p > 0.99), Clavien-Dindo grade III or IV complications (37.5% versus 30.0%, p > 0 .99), length of stay (6.0 versus 5.5 days, p = 0.67), or 90-day readmission (20.8% versus 50.0%, p = 0.09). The ratio of the mean cost of RAPD to TLPD was 0.95 for disposable items (95% CI 0.60-2.16) and 1.04 for total operative costs (95% CI 0.81-1.41). There was no 90-day mortality in either group.
Discussion: In this single surgeon experience, transitioning from RAPD to TLPD was not associated with an additional learning curve. TLPD in this setting is associated with improved time to resection, and equivalent technical, pathologic, and clinical outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84910
Program Number: P540
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster