title: Robotic pancreatoduodenectomy with vascular resection.
abstract: OBJECTIVE
  This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV).
  
  
  METHODS
  Our experience on RPD, including RPD-SMV/PV, is presented along with a description of the surgical technique and a systematic review of the literature on RPD-SMV/PV.
  
  
  RESULTS
  We have performed 116 RPD and 14 RPD-SMV/PV. Seven additional cases of RPD-SMV/PV were identified in the literature. In our experience, RPD and RPD-SMV/PV were similar in all baseline variables, but lower mean body mass and higher prevalence of pancreatic cancer in RPD-SMV/PV. Regarding the type of vein resection, there were one type 2 (7.1 %), five type 3 (35.7 %) and eight type 4 (57.2 %) resections. As compared to RPD, RPD-SMV/PV required longer operative time, had higher median estimated blood loss, and blood transfusions were required more frequently. Incidence and severity of post-operative complications were not increased in RPD-SMV/PV, but post-pancreatectomy hemorrhage occurred more frequently after this procedure. In pancreatic cancer, RPD-SMV/PV was associated with a higher mean number of examined lymph nodes (60.0 ± 13.9 vs 44.6 ± 11.0; p = 0.02) and with the same rate of microscopic margin positivity (25.0 % vs 26.1 %). Mean length or resected vein was 23.1 ± 8.08 mm. Actual tumour infiltration was discovered in ten patients (71.4 %), reaching the adventitia in four patients (40.0 %), the media in two patients (20.0 %), and the intima in four patients (40.0 %). Literature review identified seven additional cases, all reported to have successful outcome.
  
  
  CONCLUSIONS
  RPD-SMV/PV is feasible in carefully selected patients. The generalization of these results remains to be demonstrated.
authors.affiliation: Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Emanuele F
authors.initials: EF
authors.lastname: Kauffmann
authors.affiliation: Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Napoli
authors.affiliation: Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Menonna
authors.affiliation: Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.affiliation: Division of Anesthesia and Intensive Care, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
authors.affiliation: Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Campani
authors.affiliation: Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Luca Emanuele
authors.initials: LE
authors.lastname: Pollina
authors.affiliation: Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Niccola
authors.initials: N
authors.lastname: Funel
authors.affiliation: Division of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Cappelli
authors.affiliation: Division of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Caramella
authors.affiliation: Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy. u.boggi@med.unipi.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
mesh_terms: D006801:Humans; D008642:Mesenteric Veins / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: Laparoscopic pancreatoduodenectomy; Pancreas cancer; Pancreatoduodenectomy; Robotic pancreatoduodenectomy; Vein resection