title: Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study.
abstract: BACKGROUND
  The enhanced dexterity offered by robotic assistance could be excessive for distal pancreatectomy but not enough to improve the outcome of laparoscopic pancreaticoduodenectomy. Total pancreatectomy retains the challenges of uncinate process dissection and digestive reconstruction, but avoids the risk of pancreatic fistula, and could be a suitable operation to highlight the advantages of robotic assistance in pancreatic resections.
  
  
  METHODS
  Eleven laparoscopic robot-assisted total pancreatectomies (LRATP) were compared to 11 case-matched open total pancreatectomies. All operations were performed by one surgeon during the same period of time. Robotic assistance was employed in half of the patients, based on robot availability at the time of surgery. Variables examined included age, sex, American Society of Anesthesiologists score, body mass index, estimated blood loss, need for blood transfusions, operative time, tumor type, tumor size, number of examined lymph nodes, margin status, post-operative complications, 90-day or in-hospital mortality, length of hospital stay, and readmission rate.
  
  
  RESULTS
  No LRATP was converted to conventional laparoscopy, hand-assisted laparoscopy or open surgery despite two patients (18.1 %) required vein resection and reconstruction. LRATP was associated with longer mean operative time (600 vs. 469 min; p = 0.014) but decreased mean blood loss (220 vs. 705; p = 0.004) than open surgery. Post-operative complications occurred in similar percentages after LRATP and open surgery. Complications occurring in most patients (5/7) after LRATP were of mild severity (Clavien-Dindo grade I and II). One patient required repeat laparoscopic surgery after LRATP, to drain a fluid collection not amenable to percutaneous catheter drainage. One further patient from the open group required repeat surgery because of bleeding. No patient had margin positive resection, and the mean number of examined lymph nodes was 45 after LRATP and 36 after open surgery.
  
  
  CONCLUSIONS
  LRATP is feasible in selected patients, but further experience is needed to draw final conclusions.
authors.affiliation: Division of General and Transplant Surgery, Pisa University Hospital Pisa, Via Paradisa 2, 56124, Pisa, Italy, u.boggi@med.unipi.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.forename: Simona
authors.initials: S
authors.lastname: Palladino
authors.forename: Gabriele
authors.initials: G
authors.lastname: Massimetti
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.forename: Fabio
authors.initials: F
authors.lastname: Caniglia
authors.forename: Nelide
authors.initials: N
authors.lastname: De Lio
authors.forename: Vittorio
authors.initials: V
authors.lastname: Perrone
authors.forename: Linda
authors.initials: L
authors.lastname: Barbarello
authors.forename: Mario
authors.initials: M
authors.lastname: Belluomini
authors.forename: Stefano
authors.initials: S
authors.lastname: Signori
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*