Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 25:12:834382.
doi: 10.3389/fonc.2022.834382. eCollection 2022.

Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

Lanwei Ouyang  1 , Jia Zhang  2 , Qingbo Feng  3 , Zhiguang Zhang  1 , Hexing Ma  4 , Guodong Zhang  4
Affiliations

Robotic Versus Laparoscopic Pancreaticoduodenectomy: An Up-To-Date System Review and Meta-Analysis

Lanwei Ouyang et al. Front Oncol. .

Abstract

Background: Although minimally invasive pancreaticoduodenectomy has gained worldwide interest, there are limited comparative studies between two minimally invasive pancreaticoduodenectomy techniques. This meta-analysis aimed to compare the safety and efficacy of robotic and laparoscopic pancreaticoduodenectomy (LPD), especially the difference in the perioperative and short-term oncological outcomes.

Methods: PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before July 2021. Data on operative times, blood loss, overall morbidity, major complications, vascular resection, blood transfusion, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), conversion rate, reoperation, length of hospital stay (LOS), and lymph node dissection were subjected to meta-analysis.

Results: Overall, the final analysis included 9 retrospective studies comprising 3,732 patients; 1,149 (30.79%) underwent robotic pancreaticoduodenectomy (RPD), and 2,583 (69.21%) underwent LPD. The present meta-analysis revealed nonsignificant differences in operative times, overall morbidity, major complications, blood transfusion, POPF, DGE, reoperation, and LOS. Alternatively, compared with LPD, RPD was associated with less blood loss (p = 0.002), less conversion rate (p < 0.00001), less vascular resection (p = 0.0006), and more retrieved lymph nodes (p = 0.01).

Conclusion: RPD is at least equivalent to LPD with respect to the incidence of complication, incidence and severity of DGE, and reoperation and length of hospital stay. Compared with LPD, RPD seems to be associated with less blood loss, lower conversion rate, less vascular resection, and more retrieved lymph nodes.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD2021274057.

Keywords: Da Vinci; laparoscopic pancreaticoduodenectomy; meta-analysis; minimally invasive surgery; robotic pancreaticoduodenectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study identification and selection.
Figure 2
Figure 2
Forest plot of comparison of RPD versus LPD for operative outcomes. (A) Forest plot for operative time. (B) Forest plot for blood loss. RPD, robotic pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy.
Figure 3
Figure 3
Forest plot of comparison of RPD versus LPD for postoperative outcomes. (A) Forest plot for a number of retrieved lymph nodes. (B) Forest plot for the length of stay. RPD, robotic pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy.
Figure 4
Figure 4
Forest plot of comparison of RPD versus LPD. (A) Forest plot for overall complications. (B) Forest plot for major complications. RPD, robotic pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy.
Figure 5
Figure 5
Forest plot of comparison of RPD versus LPD. (A) Forest plot for postoperative pancreatic fistula. (B) Forest plot for delayed gastric emptying. RPD, robotic pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy.
Figure 6
Figure 6
Forest plot of comparison of RPD versus LPD. (A) Forest plot for vascular resection. (B) Forest plot for blood transfusion. RPD, robotic pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy.
Figure 7
Figure 7
Forest plot of comparison of RPD versus LPD. (A) Forest plot for conversion rate. (B) Forest plot for reoperation. RPD, robotic pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy.
Figure 8
Figure 8
Funnel plots for (A) overall complications and (B) postoperative pancreatic fistula.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Strobel O, Neoptolemos J, Jäger D, Büchler MW. Optimizing the Outcomes of Pancreatic Cancer Surgery. Nat Rev Clin Oncol (2019) 16(1):11–26. doi: 10.1038/s41571-018-0112-1 - DOI - PubMed
    1. Gagner M, Pomp A. Laparoscopic Pylorus-Preserving Pancreatoduodenectomy. Surg Endosc (1994) 8(5):408–10. doi: 10.1007/BF00642443 - DOI - PubMed
    1. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al. . Robotics in General Surgery: Personal Experience in a Large Community Hospital. Arch Surg (2003) 138(7):777–84. doi: 10.1001/archsurg.138.7.777 - DOI - PubMed
    1. Gumbs AA, Rodriguez Rivera AM, Milone L, Hoffman JP. Laparoscopic Pancreatoduodenectomy: A Review of 285 Published Cases. Ann Surg Oncol (2011) 18(5):1335–41. doi: 10.1245/s10434-010-1503-4 - DOI - PubMed
    1. Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC. Robotic Versus Open Pancreaticoduodenectomy: A Comparative Study at a Single Institution. World J Surg (2011) 35(12):2739–46. doi: 10.1007/s00268-011-1276-3 - DOI - PubMed

Publication types

LinkOut - more resources