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Yu Y, Changyong E, Lin C, Wang L, Jiang T. Safety and learning curve analysis of robotic-assisted pancreaticoduodenectomy: experience of a single surgeon. J Robot Surg 2024; 18:92. [PMID: 38400999 DOI: 10.1007/s11701-024-01844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/21/2024] [Indexed: 02/26/2024]
Abstract
Although prior studies have discussed learning curves (LC) of robotic-assisted pancreaticoduodenectomy (RPD), a recognized definition is lacking. This study analyzed the clinical outcomes of 85 consecutive RPD cases performed by a single surgeon to evaluate the safety and learning curve of RPD using the da Vinci Xi robotic system. There were 51 male and 34 female patients, with a median age of 64 (20-87) years. The average preoperative body weight and BMI were 64.15 ± 11.43 kg and 23.36 ± 3.33 kg/m2, respectively. The clinical outcomes of each patient were analyzed using the textbook outcome(TO), and the learning curve of the RPD was evaluated by calculating the TO rate of patients using the cumulative sum analysis method (CUSUM).The operation time (OT) was 288.92 ± 44.41 min, and the postoperative hospital stay was 10 (1-134) days. In total, 23.52% (20/85), 5.88% (5/85), 2.35% (2/85), and 5.9% (5/85) experienced grade IIIa, IIIb, IV, and V complications. A total of 46 patients achieved TO outcomes (TO group), while 39 did not (non-TO group). The smoking rate in the TO group was lower (P < 0.05) and the albumin level was higher (P < 0.05) than that in the non-TO group. The TO rate became positive after the 56th case, all patients were divided into a learning improvement group (56 cases) and a proficient group (29 cases). The total bilirubin level in the learning improvement group was lower (P < 0.05) and the bleeding volume was higher (P < 0.05).RPD is safe and effective for carefully selected patients. The learning curve was completed after 56 patients.
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Affiliation(s)
- Yang Yu
- Hapatobiliary and Pancreatic Surgery Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - E Changyong
- Hapatobiliary and Pancreatic Surgery Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Chao Lin
- Hapatobiliary and Pancreatic Surgery Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Lun Wang
- Hapatobiliary and Pancreatic Surgery Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Tao Jiang
- Hapatobiliary and Pancreatic Surgery Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
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Guadagni S, Comandatore A, Furbetta N, Di Franco G, Carpenito C, Bechini B, Vagelli F, Ramacciotti N, Palmeri M, Di Candio G, Morelli L. Robotic Hepatectomy plus Biliary Reconstruction for Bismuth Type III and Type IV Hilar Cholangiocarcinoma: State of the Art and Literature Review. J Pers Med 2023; 14:12. [PMID: 38276227 PMCID: PMC10817587 DOI: 10.3390/jpm14010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND In Bismuth type III and IV Hilar Cholangiocarcinoma (III-IV HC), surgical resection is the only chance for long-term survival. As the surgical procedure is complex and Robotic-Assisted Surgery (RAS) may be particularly suitable in this setting, the aim of this study is to evaluate the potential benefits of RAS in III-IV HC in terms of post-operative outcomes. METHODS We conducted a systematic review using the PRISMA checklist for article selection. We searched the PubMed database and included only studies with clinical data about the treatment of III-IV HC using RAS. RESULTS A total of 12 papers involving 50 patients were included. All cases were Bismuth IIIa (n = 18), IIIb (n = 27) or IV type (n = 5) and underwent hepatectomy with biliary confluence resection and reconstruction. The mean operative time was 500 minutes with a conversion rate of 4%. The mean hospital stay was 12.2 days, and the morbidity and 30-day mortality rate were 61.9% and 2%, respectively. Over a mean follow up period of 10.1 months, 9/18 cases experienced recurrence (50%). CONCLUSIONS RAS for III-IV HC is safe and feasible, at least if performed by experienced surgeons on selected cases. The oncological outcomes appear acceptable, given the aggressiveness of this pathology, but further studies are needed to fully elucidate the exact role of robotics in this setting.
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Affiliation(s)
- Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Annalisa Comandatore
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Cristina Carpenito
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Bianca Bechini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Filippo Vagelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Niccolò Ramacciotti
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.G.); (A.C.); (G.D.F.); (C.C.); (B.B.); (F.V.); (N.R.); (M.P.); (G.D.C.); (L.M.)
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, 56126 Pisa, Italy
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Bauschke A, Deeb AA, Kissler H, Rohland O, Settmacher U. [Anastomotic techniques in minimally invasive hepatobiliopancreatic surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:775-779. [PMID: 37405414 DOI: 10.1007/s00104-023-01901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
The established anastomotic techniques conventionally used in open surgery are increasingly being implemented in a minimally invasive approach and further developed. The aim of all innovations is to carry out a safe anastomosis with a feasible minimally invasive technique; however, there is currently no broad consensus about the role of laparoscopic and robotic surgery in performing pancreatic anastomotic techniques. Pancreatic fistulas determine the morbidity following a minimally invasive resection. The simultaneous minimally invasive resection and reconstruction of pancreatic processes and vascular structures is currently exclusively performed in specialized centers.
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Affiliation(s)
- Astrid Bauschke
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland.
| | - Aladdin Ali Deeb
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - Hermann Kissler
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - Oliver Rohland
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
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Ross SB, Slavin M, Sucandy I, Crespo KL, Syblis CC, Saravanan S, Rosemurgy AS. Comparative Analysis of NSQIP National Outcomes and Projected Outcomes versus Our Institutional Outcomes for Robotic Gastrectomy: The Future of Gastric Resection. Am Surg 2023; 89:3757-3763. [PMID: 37217206 DOI: 10.1177/00031348231175139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The robotic approach has vast applications in surgery; however, the utility of robotic gastrectomy has yet to be clearly defined. This study aimed to compare outcomes following robotic gastrectomy at our institution to the national patient-specific predicted outcomes data provided by the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). METHODS We prospectively studied 73 patients who underwent robotic gastrectomy under our care. ACS NSQIP outcomes after gastrectomy and predicted outcomes for our patients were compared with our actual outcomes utilizing students t test and chi-square analysis, where applicable. Data are presented as median (mean ± SD). RESULTS Patients were 65 (66 ± 10.7) years old with a BMI of 26 (28 ± 6.5) kg/m2. 35 patients had gastric adenocarcinomas and 22 had gastrointestinal stromal tumors Operative duration was 245 (250 ± 114.7) minutes, estimated blood loss was 50 (83 ± 91.6) mL, and there were no conversions to 'open'. 1% of patients experienced superficial surgical site infections compared to the NSQIP predicted rate of 10% (P < .05). Length of stay (LOS) was 5 (6 ± 4.2) days vs NSQIP's predicted LOS of 8 (8 ± 3.2) days (P < .05). Three patients died during their postoperative hospital course (4%), due to multi-system organ failure and cardiac arrest. 1-year, 3-year, and 5-year estimated survival for patients with gastric adenocarcinoma was 76%, 63%, and 63%, respectively. DISCUSSION Robotic gastrectomy yields salutary patient outcomes and optimal survival for varying gastric diseases, particularly gastric adenocarcinoma. Our patients experienced shorter hospital stays and reduced complications relative to patients in NSQIP and predicted outcome for our patients. Gastrectomy undertaken robotically is the future of gastric resection.
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Affiliation(s)
- Sharona B Ross
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Moran Slavin
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iswanto Sucandy
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
| | | | | | - Sneha Saravanan
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
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