Robotic-Assisted Major Pancreatic Resection and Reconstruction

Hypothesis: Robotic-assisted pancreatic resection and reconstruction are safe and can reproduce perioperative results seen in open surgery. Design: Single-institution retrospective review. Setting: Tertiary care center. Patients: Patients undergoing completed robotic-assisted pancreatic resection and reconstruction at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, between October 3, 2008, and February 26, 2010. Main Outcome Measures: Primary pathology, operative time, operative blood loss, perioperative blood transfusions, pancreatic fistula, 90-day morbidity and mortality, and readmission rate. Results: Thirty patients with a median age of 70 years (range, 32-85 years) underwent completed robotic-assisted pancreatic resection and reconstruction. Procedures were robotic-assisted non-pylorus-preserving pancreaticoduodenectomy (n=24), robotic-assisted central pancreatectomy (n=4), and the robotic-assisted Frey procedure (n=2). The median operative time was 512 minutes (range, 327-848 minutes). The median blood loss was 320mL(range, 50-1000 mL), with a median length of hospital stay of 9 days (range, 4-87 days). The final diagnoses included periampullary adenocarcinoma (n=7), pancreatic ductal adenocarcinoma (n=6), pancreatic neuroendocrine tumor (n=5), intraductal papillary mucinous neoplasm (n=4), mucinous cystic neoplasm (n=3), serous cysticadenoma(n=2), chronic pancreatitis (n=2), and solid pseudopapillary neoplasm (n=1). There was 1 postoperative death. The overall pancreatic fistula rate was 27% (n=8). The clinically significant pancreatic fistula rate (International Study Group on Pancreatic Fistula grades B and C) was 10% (n=3). Clavien grade III and IV complications occurred in 7 patients (23%), while Clavien grade I and II complications occurred in 8 patients (27%). Conclusions: Robotic-assisted complex pancreatic surgery can be performed safely in a high-volume pancreatic tertiary care center with perioperative outcomes comparable to those of open surgery. Advances in robotic technology and increasing experience may improve long operative times.