title: Robotic-assisted major pancreatic resection and reconstruction.
abstract: OBJECTIVE
  Robotic-assisted pancreatic resection and reconstruction are safe and can reproduce perioperative results seen in open surgery.
  
  
  METHODS
  Single-institution retrospective review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  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.
  
  
  METHODS
  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 320 mL (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 cystic adenoma (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.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center Pancreatic Cancer Center, 3550 Terrace St., Pittsburgh, PA 15261, USA.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Nguyen
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000503:physiopathology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome