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Comparative analysis of open, laparoscopic and robotic distal pancreatic resection: The United Kingdom′s first single-centre experience

Lookup NU author(s): Nathania Sutandi, Gourab Sen, John Hammond, Professor Derek Manas, Jeremy French, Steven White



This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).


© 2022 Wolters Kluwer Medknow Publications. All rights reserved. Introduction: Laparoscopic distal pancreatectomy (LDP) has potential advantages over its open equivalent open distal pancreatectomy (ODP) for pancreatic disease in the neck, body and tail. Within the United Kingdom (UK), there has been no previous experience describing the role of robotic distal pancreatectomy (RDP). This study evaluated differences between ODP, LDP and RDP. Methods: Patients undergoing distal pancreatectomy performed in the Department of Hepatobiliary and Pancreatic Surgery at the Freeman Hospital between September 2007 and December 2018 were included from a prospectively maintained database. The primary outcome measure was length of hospital stay, and the secondary outcome measures were complication rates graded according to the Clavien-Dindo classification. Results: Of the 125 patients, the median age was 61 years and 46% were male. Patients undergoing RDP (n = 40) had higher American Society of Anesthesiologists grading III compared to ODP (n = 38) and LDP (n = 47) (57% vs. 37% vs. 38%, P = 0.02). RDP had a slightly lower but not significant conversion rate (10% vs. 13%, P = 0.084), less blood loss (median: 0 vs. 250 ml, P < 0.001) and a higher rate of splenic preservation (30% vs. 2%, P < 0.001) and shorter operative time, once docking time excluded (284 vs. 300 min, P < 0.001) compared to LDP. RDP had a higher R0 resection rate than ODP and LDP (79% vs. 47% vs. 71%, P = 0.078) for neoplasms. RDP was associated with significantly shorter hospital stay than LDP and ODP (8 vs. 9 vs. 10 days, P = 0.001). While there was no significant different in overall complications across the groups, RDP was associated with lower rates of Grade C pancreatic fistula than ODP and LDP (2% vs. 5% vs. 6%, P = 0.194). Conclusion: Minimally invasive pancreatic resection offers potential advantages over ODP, with a trend showing RDP to be marginally superior when compared to conventional LDP, but it is accepted that that this is likely to be at greater expense compared to the other current techniques.

Publication metadata

Author(s): Kamarajah S, Sutandi N, Sen G, Hammond J, Manas D, French J, White S

Publication type: Article

Publication status: Published

Journal: Journal of Minimal Access Surgery

Year: 2022

Volume: 18

Issue: 1

Pages: 77-83

Print publication date: 03/01/2022

Online publication date: 06/05/2021

Acceptance date: 30/11/2020

Date deposited: 08/02/2022

ISSN (print): 0972-9941

ISSN (electronic): 1998-3921

Publisher: Wolters Kluwer Medknow Publications


DOI: 10.4103/jmas.JMAS_163_20


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