title: Robotic versus laparoscopic distal pancreatectomy - The first meta-analysis.
abstract: Minimally invasive pancreaticoduodenectomy is considered hazardous for the majority of authors and minimally distal pancreatectomy is still a debated topic. The aim of this study was to compare robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP) using meta-analysis.
  
  
  
  EMBASE, Medline and PubMed were searched systematically to identify full-text articles comparing robotic and laparoscopic distal pancreatectomies. The meta-analysis was performed by using Review Manager 5.3.
  
  
  
  Nine studies fulfilled the inclusion criteria and included 637 patients (246 robotic and 391 laparoscopic). RDP had a shorter hospital length of stay by 1 day (P = 0.01). On the other hand, LDP had shorter operative time by 30 min, although this was statistically nonsignificant (P = 0.12). RDP showed a significantly increased readmission rate (P = 0.04). There was no difference in the conversion rate, incidence of postoperative pancreatic fistula, International Study Group of Pancreatic Fistula grade B-C rate, major morbidity, spleen preservation rate and perioperative mortality. All surgical specimens of RDP reported R0 negative margins, whereas 7 specimens in the LDP group had affected margins.
  
  
  
  In terms of feasibility, safety and oncological adequacy, there is no essential difference between the two techniques so far. The 30 min longer operative time of the RDP is due to the docking and undocking of the robot. The shorter length of stay by 1 day should be judged in combination with the increased 90-day readmission rate.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Paschalis
authors.initials: P
authors.lastname: Gavriilidis
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Menahem
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; INSERM U 955, Créteil, France. Electronic address: daniel.azoulay@hmn.aphp.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D000072662:Margins of Excision; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010359:Patient Readmission; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult