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Robotic versus conventional laparoscopic distal pancreatic resection: a systematic review and meta-analysis

Lookup NU author(s): Nathania Sutandi, Jeremy French, Steven White


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© 2019 International Hepato-Pancreato-Biliary Association Inc. Background: Robotic surgery offers theoretical advantages to conventional laparoscopic surgery including improved instrument dexterity, 3D visualization and better ergonomics. This review aimed to determine if these theoretical advantages translate into improved patient outcomes in patients undergoing distal pancreatectomy through laparoscopic (LDP) or robotic (RDP) approaches. Method: A systematic literature search was conducted for studies reporting minimally invasive surgery for distal pancreatectomy. Meta-analysis of intraoperative (blood loss, operating times, conversion and R0 resections) and postoperative outcomes (overall complications, pancreatic fistula, length of hospital stay) was performed using random effects models. Result: Twenty non-randomised studies including 3112 patients (793 robotic and 2319 laparoscopic) were considered appropriate for inclusion. LDP had significantly shorter operating time than RDP (mean: 28, p < 0.001) but no significant difference in blood loss (mean: 52 mL, p = 0.07). RDP was associated with significantly lower conversion rates than LDP (OR 0.48, p < 0.001), but no difference in spleen preservation rate and R0 resection. There were no significant differences in overall and major complications, overall and high-grade pancreatic fistula. However, RDP was associated with a shorter length of hospital stay (mean: 1, p < 0.001). Conclusion: Robotic distal pancreatectomy appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomised trial comparing both techniques are needed.

Publication metadata

Author(s): Kamarajah SK, Sutandi N, Robinson SR, French JJ, White SA

Publication type: Review

Publication status: Published

Journal: HPB

Year: 2019

Volume: 21

Issue: 9

Pages: 1107-1118

Print publication date: 01/09/2019

Online publication date: 05/04/2019

Acceptance date: 18/02/2019

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.


DOI: 10.1016/j.hpb.2019.02.020