Old Dogs and New Techniques: Comparing Complete Robotic Adoption to Laparoscopic Surgery-A Single Institution Experience with Distal Pancreatectomies

The laparoscopic distal pancreatectomy (LDP) is superior to the open approach; however, proximal dissection, hand-assisted (HA) approaches and conversion to open resection can be improved upon.Robotic distal pancreatectomy (RDP) addresses the limitations of LDP with better optics (3D), magnification, instrument/ visual stabilization and dexterity of the instrumentation.We sought to investigate RDP vs. LDP and to introduce a new variable, tumor distance from the superior mesenteric vein (SMV), to assess how proximal the dissection was performed.A consecutive sample of 45 patients who underwent minimally invasive distal pancreas resection between 2/1/2012 to 6/30/2018 was completed.Typical demographics and clinicopathologic variables were collected, including outcomes.Overall, 22 LDPs and 23 RDPs, were evaluated.No demographics, comorbidities, or ASA score were significantly different between the cohorts.Neither differences in tumor size (LDP: 3.4cm +/-2.8,RDP: 3.1cm +/-1.9;p=0.80) or distance from the SMV (LDP: 4.1cm +/-3.0,RDP: 3.9 cm+/-2.9;p = 0.89) were significantly different.Positive margins were similar between groups; lymph nodes were less with LDP than RDP (mean 6.4 and 10, respectively; p=0.09).Post-operative complications and length of stay (mean 5.4 and 5.3 days, respectively) were similar between groups (p=0.27;p=0.94).We show that converting to an entirely robotic approach for distal pancreatectomies is safe, effective, with potentially better lymph node dissection and a learning curve that demonstrates adoption at any level of post residency training.Additionally, tumor distance from the SMV/portal vein confluence could help quantify the theoretical technical advantages of robotic distal pancreatectomy.