title: A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) is increasing in popularity thanks to the benefits that have been recently demonstrated by many authors. The Da Vinci(®) Surgical System could overcome some limits of laparoscopy, helping the surgeons to perform safer and faster difficult procedures. Nowadays, prospective clinical trials comparing LDP to robotic distal pancreatectomy (RDP) are lacking. The aim of this study is to present a prospective comparison between the two techniques.
  
  
  METHODS
  Since November 2011, all patients suitable for minimally invasive distal pancreatectomy were assigned either to LDP or RDP, depending on the availability of the Da Vinci(®) Surgical System for our Surgical Unit. Demographics, clinical, and intra- and postoperative data, including estimated costs of the procedure, were prospectively collected. Follow-up included cross-sectional imaging ended on April 2014.
  
  
  RESULTS
  Twenty-two patients underwent RDP and 21 LDP; patients' characteristics were similar. The median operative time was longer and procedures' cost was double in RDP group. The conversion to open rate and the median length of postoperative hospital stay were 4.5 % and 7 days, respectively, in both groups. Pancreatic fistula developed in 57.1 % (12/21) and 50 % (11/22) of LDP and RDP, respectively (p = 0.870), being grade A the most frequent. Mortality was nil and an R0 resection was achieved in all Patients. The overall number of lymph nodes harvested was similar between the two groups.
  
  
  CONCLUSIONS
  Both RDP and LDP are valid techniques for the treatment of distal pancreatic tumors. The advantages of RDP are claimed by many but still under investigation. Some of these advantages are more subjective than objective, and it seems difficult to demonstrate a real superiority of one technique over the other in a standardized fashion. In our experience, laparoscopy has not been abandoned in favor of the robot: we continue to perform both approaches choosing upon single patient's characteristics.
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. giovanni.butturini@ospedaleuniverona.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Isacco
authors.initials: I
authors.lastname: Damoli
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Crepaz
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Despoina
authors.initials: D
authors.lastname: Daskalaki
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Esposito
authors.affiliation: Department of Oncology, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Cingarlini
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.affiliation: General Surgery B, The Pancreas Institute, Verona University Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D055815:Young Adult
keywords: Distal pancreatectomy; Laparoscopy; Pancreatic surgery; Prospective study; Robot-assisted surgery; Robotic surgery