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Case Reports
. 2018 Aug 16;16(1):171.
doi: 10.1186/s12957-018-1468-5.

Preliminary clinical experience with robotic retroperitoneoscopic pancreatic surgery

Guodong Zhao  1 , Zizheng Wang  1 , Minggen Hu  1 , Sai Chou  1 , Xin Ma  2 , Xiangjun Lv  2 , Zhiming Zhao  1 , Yong Xu  1 , Zhipeng Zhou  1 , Rong Liu  3
Affiliations
Case Reports

Preliminary clinical experience with robotic retroperitoneoscopic pancreatic surgery

Guodong Zhao et al. World J Surg Oncol. .

Abstract

Backgrounds: Retroperitoneoscopic surgery has shown advantages in urological surgery. However, its application in pancreatic surgery for neoplasm is rare. Robotic surgical system with its magnified view and flexible instruments may provide a superior alternative to conventional laparoscopic system in retroperitoneoscopic surgery. We aimed to evaluate the safety, feasibility, and short-term outcomes in a series of patients treated by robotic retroperitoneoscopic pancreatic surgery.

Case presentation: Between March 2016 and May 2016, four patients with solitary pancreatic neuroendocrine neoplasms were treated with robotic retroperitoneoscopic surgery. Prospective collected clinical data were retrospectively analyzed. Three patients underwent distal pancreatectomy (one combined with resection of left adrenal adenoma), and one patient enucleation. The mean operative time was 80 min (range 30-110 min). The estimated blood loss was insignificant. There was no conversion to open procedure. The mean postoperative hospital stay was 5.25 days (range 4-6 days). The mean tumor size was 1.375 cm (range 1.0-1.8 cm) in diameter. All patients' blood glucose level returned to normal range within 1 week postoperatively. Two patients had pancreatic biochemical leak. No patients underwent subsequent treatment, and no recurrence occurred during the 12-month follow-up period.

Conclusions: This study preliminarily indicates that robotic retroperitoneoscopic pancreatic surgery is safe and feasible for neoplasms in the dorsal portion of distal pancreas in selected patients, with some potential advantages of straightforward access, simple and fine manipulation, short operative time, and fast recovery.

Keywords: Distal pancreatectomy; Enucleation; Neoplasm; Pancreas; Retroperitoneoscopic surgery; Robotic surgery.

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Conflict of interest statement

Ethics approval and consent to participant

Ethical approval for this medical study involving human subjects has respected the Helsinki ethical principles.

Consent for publication

Informed consent was obtained from the patients for the publication and accompanying images.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Contrast-enhanced CT showing a tumor located in the dorsal portion of pancreatic tail, close to splenic vessels. The arrow indicates the tumor
Fig. 2
Fig. 2
Trocar placement of robotic retroperitoneoscopic pancreatic surgery. LAAL, left anterior axillary line; LPAL, left posterior axillary line; C, camera port; A, assistant port; R1, first robotic arm; R2, second robotic arm
Fig. 3
Fig. 3
Application of intraoperative ultrasonography to location of the tumor and ensure adequate resection extent after exposing the distal pancreas. Yellow lines, distal pancreas; blue dashed lines, spleen
Fig. 4
Fig. 4
Segmental ligation of splenic vessels before the distal pancreas resection in the robotic retroperitoneoscopy. Blue lines, splenic vein; red lines, splenic artery
Fig. 5
Fig. 5
Exposure of the dorsal portion of distal pancreas and location of the tumor in a robotic retroperitoneoscopic pancreatic enucleation. Blue lines, splenic vein; red lines, splenic artery
See this image and copyright information in PMC

References

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