title: Pancreatic enucleation using the da Vinci robotic surgical system: a report of 26 cases.
abstract: BACKGROUND
  As a tissue-sparing procedure, pancreatic enucleation has become an alternative for benign or borderline pancreatic tumours; it has been proved to be safe and feasible. To date, a large sample size of robotic pancreatic enucleation has not been reported. This study aimed to discuss the clinical evaluation and postoperative complications after robotic pancreatic enucleation and compare it with open surgery.
  
  
  METHODS
  Patients who underwent robotic or open pancreatic enucleation during December 2010-December 2014 at Shanghai Ruijin Hospital, affiliated with the Shanghai Jiaotong University School of Medicine in China, were included. Clinical data were collected and analysed.
  
  
  RESULTS
  Patients were divided into an open group and a robotic group: 26 patients underwent robotic pancreatic enucleation, of whom 13 patients were female. The mean age was 51.7 years, the operation time was 125.7 ± 58.8 min, blood loss was 49.4 ± 33.4 ml and mean tumour size was 18.8 ± 7.9 mm; 17 patients underwent open pancreatic enucleation, of whom 11 were female. The mean age was 54.6 ± 17.2 min, blood loss was 198.5 ± 70.7 ml and mean tumour size was 3.5 ± 1.9 cm. Pathology included insulinomas, intrapancreatic mucinous neoplasmas (IPMNs), pancreatic neuro-endocrine tumours (PNETs), solid pseudopapillary tumours (SPTs) and serous cystadenomas (SCAs). Robotic pancreatic enucleations were associated with less trauma, shorter operation time, less blood loss and faster wound recovery compared with open pancreatic enucleation. Pancreatic fistulas (PFs) were the main complication that occurred in the robotic group; infection also occurred in the open group. All patients recovered after effective drainage and the use of somatostatin. The mean follow-up time was 25 months. No recurrence was discovered, and one patient in the open group suffered endocrine insufficiency.
  
  
  CONCLUSIONS
  Robotic pancreatic enucleation is a safe and effective surgical procedure for pancreatic benign and borderline tumours. It produces less trauma than open pancreatic enucleation and might extend the indications for enucleation. The PF rate after surgery is still high and a long-term follow-up needs to be performed. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Yusheng
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Chenghong
authors.initials: C
authors.lastname: Peng
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Baiyong
authors.initials: B
authors.lastname: Shen
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Xiaxing
authors.initials: X
authors.lastname: Deng
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Jiabin
authors.initials: J
authors.lastname: Jin
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Zhichong
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhan
authors.affiliation: Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Department of Hepatobiliary Pancreatic Surgery, Shanghai Jiaotong University School of Medicine, People's Republic of China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: enucleation; pancreatic fistula; robotic surgical system