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The current state of robotic-assisted pancreatic surgery

Abstract

Pancreatic surgery is challenging for both surgeon and patient. With the advent of minimally invasive surgical techniques, patient morbidity could be reduced. However, these techniques must conform to established principles of open pancreatic surgery with regards to meticulous dissection, haemostasis and oncologic results. The robotic platform is utilized in all facets of surgery, and is being increasingly applied in pancreatic surgery. As with the introduction of any new technology, this approach must undergo rigorous examination before widespread adoption of the technique. In this article, we review the techniques and outcomes of robotic-assisted pancreatic resections, focusing on robotic-assisted pancreaticoduodenectomy, robotic-assisted distal pancreatectomy and robotic-assisted central pancreatectomy. As the outcomes of robotic-assisted surgery have yet to be rigorously evaluated against the gold standard of open surgery, this Review also highlights major laparoscopic pancreatic series in an effort to summarize the available literature on minimally invasive pancreatic surgery.

Key Points

  • The techniques of robotic-assisted pancreatic surgery can replicate the outcomes of the open approach

  • Multiple initial reports confirm that robotic-assisted pancreatic surgery is safe

  • Short-term oncologic outcomes seem to be comparable to those of open surgery, but long-term reports are still lacking

  • Detailed assessment of the benefits, costs and scope of implementation of robotic-assisted pancreatic surgery need to be carried out

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Figure 1: Port placement for robotic-assisted pancreaticoduodenectomy.
Figure 2: The creation of the tunnel under the pancreatic neck in robotic-assisted pancreaticoduodenectomy.
Figure 3: A completed portal dissection.
Figure 4: A completed pancreaticoduodenectomy dissection.
Figure 5: A pancreaticojejunostomy.
Figure 6: A hepaticojejunostomy.
Figure 7: A gastrojejunostomy.
Figure 8: The coeliac axis as seen during pancreatic neck dissection for robotic-assisted distal pancreatectomy for a pancreatic neck cancer.

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Contributions

J. Winer, H. J. Zeh and A. H. Zureikat contributed equally to all aspects of the article. M. F. Can researched data for the article and reviewed and edited the manuscript before submission. D. L. Bartlett provided substantial contribution to discussion of the content and reviewed and edited the manuscript before submission.

Corresponding author

Correspondence to Amer H. Zureikat.

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The authors declare no competing financial interests.

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Winer, J., Can, M., Bartlett, D. et al. The current state of robotic-assisted pancreatic surgery. Nat Rev Gastroenterol Hepatol 9, 468–476 (2012). https://doi.org/10.1038/nrgastro.2012.120

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