title: Comparison Between Minimally Invasive and Open Pancreaticoduodenectomy: A Systematic Review.
abstract: BACKGROUND
  Minimally invasive approaches (laparoscopic or robotic) are used in various operations. Our aim was to compare them with the open approach in pancreaticoduodenectomy.
  
  
  METHODS
  We conducted a search for articles published in MEDLINE database comparing minimally invasive (laparoscopic or robotic) with open pancreaticoduodenectomy on June 15, 2014.
  
  
  RESULTS
  Our search yielded 136 articles. We excluded 122 articles and we took into consideration 14 (10 for laparoscopic and 4 for robotic pancreaticoduodenectomies). Most cases were related to malignant diseases and tumors treated with minimally invasive operations tended to be smaller. There were relatively high conversion rates in both laparoscopic (0% to 15%) and robotic procedures (4.5% to 10%). There were no significant differences regarding resection margins, rates of pancreatic fistula formation, bile leak, and delayed gastric emptying, reoperation rates, and intraoperative and postoperative mortality. On the contrary, blood loss was less in minimally invasive than open operations, although this difference was not always significant. Moreover, totally laparoscopic and robotic procedures lasted longer than the open ones, whereas hand-assisted laparoscopic procedures did not. However, the findings regarding the number of the retrieved lymph nodes, the length of hospital stay, and costs were inconclusive and controversial.
  
  
  CONCLUSIONS
  Laparoscopic and robotic pancreaticoduodenectomy are feasible, safe, and oncologically equivalent alternatives to open pancreaticoduodenectomy. Minimally invasive operations have the advantage of the less blood loss, but totally laparoscopic and robotic procedures last longer than open procedures.
authors.affiliation: *Second Department of Propedeutic Surgery †First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Doula
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Kostakis
authors.forename: Christos
authors.initials: C
authors.lastname: Damaskos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Machairas
authors.forename: Dimitrios V
authors.initials: DV
authors.lastname: Vardakostas
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Feretis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005240:Feasibility Studies; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D010190:Pancreatic Neoplasms / Q000191:economics / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods