Robot-Assisted Pancreatic Surgery: A Structured Approach to Standardization of a Program and of the Operation

Introduction: The use of robots in minimal invasive surgery has become increasingly common in recent years.Robot-assisted pancreatoduodenectomy preponderates against a laparoscopic procedure especially due to the greater flexibility of instruments and therefore a better handling and a better angulation. Furthermore, there are benefits of enlarged 3-D visibility, software-based tremor control, and reduced physical exertion of the surgeon. Methods and Results: This review delivers a point-by-point approach to the setup of a robot-assisted pancreatic program and a detailed approach to robot-assisted pancreatoduodenectomy. Results: In our standardized standard operating procedure approach we use 5 trocars, i.e., 4 robotic trocars and 1 assist trocar. We prefer the position of the robot ports in a straight horizontal line with a distance of 20 cm from the operational field. The operation is dissected into 11 standardized procedural steps as follows: (1) access to the pancreas and visualization, (2) extended Kocher manoeuvre, (3) lower rim and mesentericoportal axis, (4) upper rim and hepatoduodenal ligament, (5) dissection of the pancreatic neck, (6) mesenteric root and pars IV duodeni, (7) mesopancreas, (8) pancreatic anastomosis reconstruction, (9) bilioenteric anastomosis, (10) dudenojejunal anastomosis, and (11) drainage and closure. The setup of the pancreas program and the structured approach to complex pancreatic resections are elucidated. Summary: This review describes the approach to robot-assisted pancreatic surgery in a high-volume pancreas center on a structural and procedural level to support the establishment of such programs at other locations.

[1]  Tobias Keck,et al.  The Indications for Laparoscopic Pancreatectomy. , 2017, Deutsches Arzteblatt international.

[2]  Masaya Suenaga,et al.  Modified Blumgart Anastomosis for Pancreaticojejunostomy: Technical Improvement in Matched Historical Control Study , 2014, Journal of Gastrointestinal Surgery.

[3]  Ugo Boggi,et al.  Multicenter outcomes of robotic reconstruction during the early learning curve for minimally-invasive pancreaticoduodenectomy. , 2017, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[4]  T. Keck,et al.  Die Pankreasanastomose – ein Videovergleich unterschiedlicher Anastomosentechniken , 2013, Zentralblatt für Chirurgie – Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.

[5]  Stephen R Grobmyer,et al.  Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. , 2010, Journal of the American College of Surgeons.

[6]  Tobias Keck,et al.  Video Tutorials Increase Precision in Minimally Invasive Surgery Training – a Prospective Randomised Trial and Follow-up Study Video-Tutorials erhöhen die Präzision im minimalinvasiven Operationstraining – eine prospektiv randomisierte Studie und Nachuntersuchung , 2018, Zentralblatt für Chirurgie.

[7]  Jian Wang,et al.  Learning Curve From 450 Cases of Robot-Assisted Pancreaticoduocectomy in a High-Volume Pancreatic Center , 2019, Annals of surgery.

[8]  Ho‐Seong Han,et al.  International consensus statement on robotic pancreatic surgery. , 2019, Hepatobiliary surgery and nutrition.

[9]  Melissa E. Hogg,et al.  Evolution of a Novel Robotic Training Curriculum in a Complex General Surgical Oncology Fellowship , 2018, Annals of Surgical Oncology.

[10]  Mario Masrur,et al.  Trans-gastric pancreaticogastrostomy reconstruction after pylorus-preserving robotic Whipple: a proposal for a standardized technique , 2018, Surgical Endoscopy.

[11]  Didier Mutter,et al.  Robotic Pancreaticoduodenectomy: Operative Steps (With Video) , 2016, Surgical laparoscopy, endoscopy & percutaneous techniques.

[12]  Ugo Boggi,et al.  Indications, technique, and results of robotic pancreatoduodenectomy , 2016, Updates in Surgery.

[13]  Amer H Zureikat,et al.  Technical Detail for Robot Assisted Pancreaticoduodenectomy. , 2019, Journal of visualized experiments : JoVE.

[14]  T Becker,et al.  [Robot-assisted Pylorus-Preserving Partial Pancreaticoduodenectomy (Kausch-Whipple Procedure)]. , 2016, Zentralblatt fur Chirurgie.

[15]  J. Qiu,et al.  Pancreatogastrostomy Versus Pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and Long-term Results of a Multicenter Randomized Controlled Trial. , 2017, Annals of surgery.

[16]  Tobias Keck,et al.  Laparoscopic Pylorus-Preserving Pancreatic Head Resection and Hybrid Open Reconstruction via Pancreatogastrostomy , 2011, Journal of Gastrointestinal Surgery.

[17]  Amer H Zureikat,et al.  Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. , 2015, JAMA surgery.

[18]  Rong Liu,et al.  The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center , 2018, Surgical Endoscopy.