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Total laparoscopic versus robotic-assisted laparoscopic pancreaticoduodenectomy: which one is better?

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Abstract

Background

Minimally invasive pancreaticoduodenectomy (MIPD) is a challenging procedure. Laparoscopic pancreaticoduodenectomy (LPD) is feasible and safe. Since the development of robotic platforms, the number of reports on robot-assisted pancreatic surgery has increased. We compared the technical feasibility and safety between LPD and robot-assisted LPD (RALPD).

Methods

From September 2012 to August 2020, 257 patients who underwent MIPD for periampullary tumors were enrolled. Of these, 207 underwent LPD and 50 underwent RALPD. We performed a 1:1 propensity score-matched (PSM) analysis and retrospectively analyzed the demographics and surgical outcomes.

Results

After PSM analysis, no difference was noted in demographics. Operation times and estimated blood loss were similar, as was the incidence of complications (p > 0.05). In subgroup analysis in patients with soft pancreas with pancreatic duct ≤ 2 mm, no significant between-group difference was noted regarding short-term surgical outcomes, including clinically relevant POPF (CR-POPF) (p > 0.05). In multivariable analysis, the only soft pancreatic texture was a predictive factor (HR 3.887, 95% confidence interval 1.121–13.480, p = 0.032).

Conclusion

RALPD and LPD are safe and effective for MIPD and can compensate each other to achieve the goal of minimally invasive surgery.

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Acknowledgements

Munseok Choi acquired and analyzed the data and drafted the manuscript. Ho Kyoung Hwang, Seoung Yoon Rho and Sung Hyun Kim revised the manuscript. Woo Jung Lee provided revision fo the article for important intellectual content. Chang Moo Kang conceived and designed the study, revised, and gave final approval to the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea

    Munseok Choi & Seoung Yoon Rho

  2. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

    Sung Hyun Kim, Ho Kyoung Hwang, Woo Jung Lee & Chang Moo Kang

  3. Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea

    Sung Hyun Kim, Ho Kyoung Hwang, Woo Jung Lee & Chang Moo Kang

  4. Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #201,50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Chang Moo Kang

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  1. Munseok Choi
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Correspondence to Chang Moo Kang.

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Drs. Munseok Choi, Seoung Yoon Rho, Sung Hyun Kim, Ho Kyoung Hwang, Woo Jung Lee, Chang Moo Kang have no conflicts of interest or financial ties to disclose.

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Choi, M., Rho, S.Y., Kim, S.H. et al. Total laparoscopic versus robotic-assisted laparoscopic pancreaticoduodenectomy: which one is better?. Surg Endosc 36, 8959–8966 (2022). https://doi.org/10.1007/s00464-022-09347-y

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