Safety of Robotic Whipples

 

Above is a photo of the da Vinci Surgical System. Not seen, is the surgeon’s console station. At the console, the surgeon sits aside the robot and can manipulate the robot’s arms to perform the surgery. Whereas a surgeon only has two arms, the robot seen above has four. These additional arms give the surgeon more options during the surgery.
Image credit: https://www.intuitive.com

The following summary comes from Emanuele F. Kauffmann, MD and colleagues, and was recently published in Surgical Endoscopy in January 2019.

Link to article: https://link.springer.com/article/10.1007%2Fs00464-018-6301-2

Over the recent decades, improvements in preoperative management and introduction of new surgical techniques has seen a substantially declined the morbidity (rate of complications) associated with pancreatic surgery. Among these, the most intriguing innovations has been the introduction of the surgical robot as a tool to assist the surgeon. When using this platform, surgeons may enjoy increased control, a 3-D view of the abdomen, and greater magnification of the surgical field, while minimizing the length of required incisions. In this article, the authors sought to evaluate the outcomes of robotic pancreatic oduodenectomy (also known as the Whipple procedure) as compared to its classic open counterpart. The authors chose to evaluate immediate oncological outcomes including resection margin status (see our August blog post on resection margins for more information). Additionally, they evaluated long-term patient outcomes including recurrence of disease and overall survival.

In order to draw meaningful conclusions, the authors performed a propensity score match. It is a widely used statistical tool that allows us to balance groups of patients that otherwise in the real world might not be similar due to various aspects of clinical decision making. Based on features of patients in one group, patients with similar characteristics are identified from the other group that serve as a control. Once done these selected groups are compared rather than the entire patient population.

Encouragingly, there were no differences observed in the rates of negative resection margins in both groups. Additionally, the authors found that the long-term outcomes including recurrence of disease and overall survival were equivalent regardless of robotic or open surgical approach.

Take home points:

  1. Surgeons can perform the same procedure, using either techniques to achieve similar rates of tumor clearance.
  2. Patients who undergo a Whipple via either technique have similar long-term outcomes.

It is important to remember that each patient and their disease is unique. Consequently, some patients may not be ideal candidates for a robotic approach. Furthermore, surgical experience and training in using a robotic console are required to use it effectively. Therefore, it should be expected that these similar outcomes are achieved when the surgeons performing the robotic procedures are trained in the field, and are past their learning curve.

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