title: Distal pancreatectomy and splenectomy: a robotic or LESS approach.
abstract: BACKGROUND
  The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy.
  
  
  METHODS
  With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD.
  
  
  RESULTS
  Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery.
  
  
  CONCLUSIONS
  Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.
authors.affiliation: Florida Hospital Tampa.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Ryan
authors.affiliation: Florida Hospital Tampa.
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.affiliation: Florida Hospital Tampa.
authors.forename: Prashant B
authors.initials: PB
authors.lastname: Sukharamwala
authors.affiliation: Florida Hospital Tampa.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sadowitz
authors.affiliation: Florida Hospital Tampa.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wood
authors.affiliation: Florida Hospital Tampa.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013156:Splenectomy / Q000379:methods*
keywords: Laparoendoscopic single-site surgery; Laparoscopic distal pancreatectomy; Robotic distal pancreatectomy and splenectomy
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