title: Early experience with robotic pancreatic surgery in a Canadian institution.
abstract: BACKGROUND
  Pancreatic resections have traditionally been associated with substantial morbidity and mortality. The robotic platform is believed to improve technical aspects of the procedure while offering minimally invasive benefits. We sought to determine the safety and feasibility of the first robotic pancreaticoduodenectomies performed at our institution.
  
  
  METHODS
  We retrospectively reviewed data on all patients who underwent robotic-assisted pancreaticoduodenectomy (RAPD) between July 2010 and June 2014 and compared them to outcomes of patients undergoing hybrid laparoscopic pancreaticoduodenectomies (HLAPD) during the same time period.
  
  
  RESULTS
  Fifteen patients were scheduled for RAPD; 2 were converted to an open approach and 1 to a mini-laparotomy during the laparoscopic portion of the procedure. Patients who had RAPD (n = 12) had a median duration of surgery of 596.6 (range 509-799) minutes, estimated blood loss of 275 (range 50-1000) mL and median length of stay of 7.5 (range 5-57) days. Mean total opioid use up to postoperative day 7 was 142.599 ± 68.2 versus 176.9 ± 112.7 mg equivalents of intravenous morphine for RAPD and HLAPD, respectively. There was no significant difference between RAPD and HLAPD in any parameters, highlighting the safety and feasibility of a step-wise minimally invasive learning platform. Most patients in the RAPD group had malignant pathology (88.2%). Oncologic outcomes were maintained with no significant difference in ability to resect lymph nodes or achieve negative margins. There were 4 (28.5%) Clavien I-II complications and 3 (29.4%) Clavien III- IV complications, 2 of which required readmission. There were no reported deaths at 90 days. Complication, pancreatic leak and mortality rates did not differ significantly from our laparoscopic experience.
  
  
  CONCLUSIONS
  Outcomes of RAPD and HLAPD were comparable at our centre, even during the early stages of our learning curve. These results also highlight the safety, feasibility and patient benefits of a step-wise transition from open to hybrid to fully robotic pancreaticoduodenectomies in a high-volume academic centre.
authors.affiliation: From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman).
authors.forename: Sabrina
authors.initials: S
authors.lastname: Piedimonte
authors.affiliation: From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman).
authors.forename: Yifan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman).
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.affiliation: From the Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que. ( Piedimonte, Wang, Bergman, Vanounou); and the Lady Davis Institute for Medical Research, Montreal, Que. (Bergman).
authors.forename: Tsafrir
authors.initials: T
authors.lastname: Vanounou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome