Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy

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Abstract
Benign and borderline malignant pancreatic tumors are increasing. Function-preserving and minimally invasive pancreatectomy may be an ideal approach for these tumors. The authors retrospectively evaluated their initial experiences with five consecutive robotic central pancreatectomies (CPs). They also compared the perioperative outcome for open CPs performed in their institution. The five women in the study had a median age of 45 years (range 36–64 years). A solid pseudopapillary tumor of the pancreas was found in four patients, and a pancreatic endocrine tumor was found in one patient. The tumor was relatively small (median size, 1.5 cm; range, 1–2 cm). All remnant pancreases were managed using pancreaticogastrostomy. The median operation time was 480 min (range 360–480 min), and the median estimated intraoperative bleeding was 200 ml (range 100–600 ml). No transfusion was given during the perioperative period. The median hospital stay was 12 days (range 9–28 days). Only one patient experienced postoperative pancreatic fistula (grade B), which was managed using the percutaneous drainage procedure. No operative morality was noted. In a comparative analysis with open CP, the robotic CP group demonstrated a smaller asymptomatic (17 out of 10 patients vs none, p = 0.026) tumor (5.9 ± 6.4 vs 1.4 ± 0.4 cm; p = 0.055), a longer operation time (286.5 ± 90.2 vs 432.0 ± 65.7 min, p = 0.013), and less intraoperative bleeding (432.0 ± 65.7 vs 286.5 ± 90.2 ml, p = 0.013). Central pancreatectomy can be selected carefully as an appropriate surgical option for benign and borderline malignant lesions limited to the pancreatic neck area. The robotic surgical system may allow surgeons to perform complex and difficult laparoscopic procedures more easily, effectively, and precisely.