Multicenter outcomes of robotic reconstruction during the early learning curve for minimally-invasive pancreaticoduodenectomy

Ammara A. Watkins, Tara S. Kent, William E. Gooding, Ugo Boggi, Sri Chalikonda, Michael L. Kendrick, R. Matthew Walsh, Herbert J. Zeh, A. James Moser

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: Perceived excess morbidity during the early learning curve of minimally-invasive pancreaticoduodenectomy (MIPD) has limited widespread adoption. It was hypothesized that robot-assisted reconstruction (RA) after MIPD allows anastomotic outcomes equivalent to open pancreaticoduodenectomy (PD). Methods: Intent to treat analysis of centrally audited data accrued during early adoption of RA-MIPD at five centers. Results: CUSUM analysis of operating times at each center identified 92 RA-MIPD during the early learning curve. Mean age was 65 ± 12 years with body mass index 25.8 ± 5.0. Surgical indications included malignant (60%) and premalignant (38%) lesions. Median operating time was 504 min (interquartile range 133) with 242 ml median estimated blood loss (IQR 398) and twelve (13%) conversions to open PD. Major complication rate (Clavien-Dindo III/IV) was 24% with 2 (2.2%) deaths and ten (10.9%) reoperations. Nine (9.9%) clinically significant pancreatic fistulae were observed (4 grade B; 5 grade C). Margin negative resection rate for malignancy was 90% (75% for PDA) with mean harvest of 16 ± 8 lymph nodes. Conclusions: These multicenter data during the early learning curve for RA-MIPD do not demonstrate excess anastomotic morbidity compared to open. Further studies are required to determine whether surgeon proficiency and evolving technique improve anastomotic outcomes compared to open.

Original languageEnglish (US)
Pages (from-to)155-165
Number of pages11
JournalHPB
Volume20
Issue number2
DOIs
StatePublished - Feb 2018
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Watkins, A. A., Kent, T. S., Gooding, W. E., Boggi, U., Chalikonda, S., Kendrick, M. L., Walsh, R. M., Zeh, H. J., & Moser, A. J. (2018). Multicenter outcomes of robotic reconstruction during the early learning curve for minimally-invasive pancreaticoduodenectomy. HPB, 20(2), 155-165. https://doi.org/10.1016/j.hpb.2017.08.032