title: Robotic-Assisted Pancreatic Resections.
abstract: Robotic assistance enhances surgical dexterity and could facilitate wider adoption of laparoscopy for pancreatic resections (PR).
  
  
  
  Data were prospectively entered into a database and analyzed retrospectively to assess feasibility and safety of robotic-assisted PR (RAPR). Additionally, robotic-assisted pancreaticoduodenectomy (RAPD) was compared to a contemporary group of open pancreaticoduodenectomies (OPD).
  
  
  
  Between October 2008 and October 2014, 200 consecutive patients underwent RAPR. Three procedures were converted to open surgery (1.5 %), despite 14 patients required associated vascular procedures. RAPD was performed in 83 patients (41.5 %), distal pancreatectomy in 83 (41.5 %), total pancreatectomy in 17 (8.5 %), tumor enucleation in 12 (6 %), and central pancreatectomy in 5 (2.5 %). Thirty-day and 90-day mortality rates were 0.5 and 1 %, respectively. Both deaths occurred after RAPD with vein resection. Complications occurred in 63.0 % of the patients (≥Clavien-Dindo grade IIIb in 4 %). Median comprehensive complication index was 20.9 (0-26.2). Incidence of grade B/C pancreatic fistula was 28.0 %. Reoperation was required in 14 patients (7.0 %). The risk of reoperation decreased after post-operative day 20 (OR 0.072) (p = 0.0015). When compared to OPD, RAPD was associated with longer mean operative time (527.2 ± 166.1 vs. 425.3 ± 92.7; <0.0001) but had an equivalent safety profile. The median number of examined lymph nodes (37; 28.8-45.3 vs. 36; 28-52.8) and the rate of margin positivity in patients diagnosed with pancreatic cancer were also similar (12.5 vs. 45.5 %).
  
  
  
  RAPR, including RAPD, are safely feasible in selected patients. The results of RAPD in pancreatic cancer are encouraging but deserve further investigation.
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. u.boggi@med.unipi.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Napoli
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Costa
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: Emanuele F
authors.initials: EF
authors.lastname: Kauffmann
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Menonna
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Iacopi
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.affiliation: Division of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D055815:Young Adult