Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Division of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Updates Surg. 2021 Jun;73(3):873-880. doi: 10.1007/s13304-021-01058-8. Epub 2021 May 20.
Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic pancreatoduodenectomy (LPD). However, major intraoperative bleeding can occur and emergency conversion to OPD may be required. RPD reduces the risk of emergency conversion when compared to LPD. The learning curve of RPD ranges from 20 to 40 procedures, but proficiency is reached only after 250 operations. Once proficiency is achieved, the results of RPD may be superior to those of OPD. As for now, RPD is at least equivalent to OPD and LPD with respect to incidence and severity of POPF, incidence and severity of post-operative complications, and post-operative mortality. A minimal annual number of 20 procedures per center is recommended. In pancreatic cancer (versus OPD), RPD is associated with similar rates of R0 resections, but higher number of examined lymph nodes, lower blood loss, and lower need of blood transfusions. Multivariable analysis shows that RPD could improve patient survival. Data from selected centers show that vein resection and reconstruction is feasible during RPD, but at the price of high conversion rates and frequent use of small tangential resections. The true Achilles heel of RPD is higher operative costs that limit wider implementation of the procedure and accumulation of a large experience at most single centers. In conclusion, when proficiency is achieved, RPD may be superior to OPD with respect to CR-POPF and oncologic outcomes. Achievement of proficiency requires commitment, dedication, and truly high volumes.
目前的证据表明，机器人胰十二指肠切除术（RPD）是可行的，其安全性与开腹胰十二指肠切除术（OPD）或腹腔镜胰十二指肠切除术（LPD）相当。然而，术中可能会发生大出血，可能需要紧急转为 OPD。与 LPD 相比，RPD 降低了紧急转换的风险。RPD 的学习曲线范围为 20 至 40 例，但需要进行 250 例手术才能达到熟练程度。一旦达到熟练程度，RPD 的结果可能优于 OPD。目前，RPD 在 POPF 的发生率和严重程度、术后并发症的发生率和严重程度以及术后死亡率方面与 OPD 和 LPD 至少相当。建议每个中心每年至少进行 20 例手术。在胰腺癌（与 OPD 相比）中，RPD 与 R0 切除率相似，但检查的淋巴结数量更多、出血量更少、输血需求更低。多变量分析表明，RPD 可以改善患者的生存。来自选定中心的数据表明，RPD 期间可以进行静脉切除和重建，但代价是高转换率和频繁使用小切线切除。RPD 的真正弱点是手术费用较高，这限制了该手术的广泛应用和大多数单一中心经验的积累。总之，当达到熟练程度时，RPD 在 CR-POPF 和肿瘤学结果方面可能优于 OPD。要达到熟练程度，需要投入、专注和真正的高工作量。
