Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis |
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| Institution: | 1. Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK;2. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK;3. College of Medical and Dental Sciences, University of Birmingham, UK;4. Department of Surgery, Centre Hospitalier Régional Orleans, Orleans, France;5. Department of Surgery and Cancer, HPB Surgical Unit, Imperial College, Hammersmith Hospital Campus, London, UK;6. Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK;1. Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, B15 2TH, UK;2. Division of Hepatobiliary Surgery, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy;1. Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy;2. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy;3. Department of Hepatobiliary and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, United Kingdom;1. Department of Surgery, University of California, San Francisco, USA;2. Department of Surgery, San Francisco VA Medical Center, USA;3. Department of Surgery, Jackson Memorial Hospital/University of Miami, USA;1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD;2. The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD;3. Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD;4. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China;1. Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee;2. Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee |
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| Abstract: | BackgroundRobotic pancreaticoduodenectomy (RPD) offers theoretical advantages to conventional laparoscopic surgery including improved instrument dexterity, 3D visualization and better ergonomics. This review aimed to determine if these theoretical advantages translate into improved patient outcomes comparing patients having either robotic pancreaticoduodenectomy or laparoscopic (LPD) equivalent.MethodA systematic literature search was conducted for studies reporting minimally invasive surgery for pancreaticoduodenectomy either robotic assisted or totally laparoscopic. Meta-analysis of intra-operative (blood loss, operating times, conversion and R0 resections) and postoperative outcomes (overall complications, pancreatic fistula, length of hospital stay) was performed using a random effects model.ResultThis review identified 44 studies, of which six were non-randomised comparative studies including 3462 patients (1025 robotic and 2437 laparoscopic). Intraoperatively, RPD was associated with significantly lower conversion rates (OR 0.45, p < 0.001) and transfusion rates (OR: 0.60, p = 0.002) compared to LPD. However, no significant difference in blood loss (mean: 220 vs 287 mL, p = 0.1), operating time (mean: 405 vs 418 min, p = 0.3) was noted. Postoperatively RPD was associated with a shorter hospital stay (mean: 12 vs 11 days, p < 0.001) but no significant difference was noted in postoperative complications, incidence of pancreatic fistulae and R0 resection rates.ConclusionRPD appears to offer some advantages compared to conventional laparoscopic surgery, although both approaches appear to offer equivalent clinical outcomes. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomised trial comparing both techniques is needed. |
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| Keywords: | Surgery Minimally invasive Robotic Outcomes |
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