Multicenter Study

. 2024 Jun 1;110(6):3554-3561.

doi: 10.1097/JS9.0000000000001315.

Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study

Eduard A van Bodegraven^{1

2}, Tess M E van Ramshorst^{1

2

3}, Svein O Bratlie⁴, Arto Kokkola⁵, Ernesto Sparrelid⁶, Bergthor Björnsson⁷, Dyre Kleive⁸, Stefan K Burgdorf⁹, Safi Dokmak¹⁰, Bas Groot Koerkamp¹¹, Santiago Sánchez Cabús¹², I Quintus Molenaar¹³, Ugo Boggi¹⁴, Olivier R Busch^{1

2}, Miha Petrič¹⁵, Geert Roeyen¹⁶, Thilo Hackert¹⁷, Daan J Lips¹⁸, Mathieu D'Hondt¹⁹, Mariëlle M E Coolsen²⁰, Giovanni Ferrari²¹, Bobby Tingstedt²², Alejandro Serrablo²³, Sebastien Gaujoux²⁴, Marco Ramera^{3

25}, Igor Khatkov²⁶, Fabio Ausania²⁷, Regis Souche²⁸, Sebastiaan Festen²⁹, Frederik Berrevoet³⁰, Tobias Keck³¹, Robert P Sutcliffe³², Elizabeth Pando³³, Roeland F de Wilde¹¹, Beatrice Aussilhou¹⁰, Paul S Krohn⁹, Bjørn Edwin⁸, Per Sandström⁷, Stefan Gilg⁶, Hanna Seppänen⁵, Caroline Vilhav⁴, Mohammad Abu Hilal³, Marc G Besselink^{1

2}; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

Collaborators, Affiliations

Collaborators

European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS):
Marcus Holmberg, Marie L Capelle, Niccolò Napoli, Maxim J L Dewulf, Alessandro Giani, Peter Holka, Charles de Ponthaud, Carolina González-Abós, Marta B Segura, Vera Hartman

Affiliations

¹ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
² Cancer Center Amsterdam, The Netherlands.
³ Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
⁴ Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
⁶ Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
⁷ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁸ Department of HPB Surgery, The Intervention Centre, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.
⁹ Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
¹⁰ Departement of HPB Surgery and Liver Transplantation, APHP Beaujon Hospital, University of Paris Cité, Clichy, France.
¹¹ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
¹² Department of HPB Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
¹³ Department of Surgery, Regional Academic Cancer Centre Utrecht, UMC Utrecht Cancer Centre and St Antonius Hospital Nieuwegein, University Medical Centre Utrecht, Utrecht, The Netherlands.
¹⁴ Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
¹⁵ Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta, Ljubljana, Slovenia.
¹⁶ Department of HPB, Endocrine and Transplantation Surgery, University Hospital Antwerp, Edegem, Belgium and University of Antwerp, Wilrijk, Belgium.
¹⁷ Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
¹⁸ Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherland.
¹⁹ Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium.
²⁰ Department of Surgery, Maastricht University Medical Center+, University of Maastricht, Maastricht, The Netherlands.
²¹ Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
²² Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
²³ HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain.
²⁴ Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
²⁵ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
²⁶ Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.
²⁷ Department of HPB and Transplant Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
²⁸ Department of Surgery, Saint-Éloi Hospital, Montpellier, France.
²⁹ Department of Surgery, OLVG, Amsterdam, The Netherlands.
³⁰ Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
³¹ Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
³² Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³³ Department of Hepato, Pancreato, Biliary, and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

PMID: 38498397
PMCID: PMC11175778
DOI: 10.1097/JS9.0000000000001315

Multicenter Study

Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study

Eduard A van Bodegraven et al. Int J Surg. 2024.

. 2024 Jun 1;110(6):3554-3561.

doi: 10.1097/JS9.0000000000001315.

Authors

Collaborators

European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS):
Marcus Holmberg, Marie L Capelle, Niccolò Napoli, Maxim J L Dewulf, Alessandro Giani, Peter Holka, Charles de Ponthaud, Carolina González-Abós, Marta B Segura, Vera Hartman

Affiliations

¹ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
² Cancer Center Amsterdam, The Netherlands.
³ Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
⁴ Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
⁶ Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
⁷ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁸ Department of HPB Surgery, The Intervention Centre, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.
⁹ Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
¹⁰ Departement of HPB Surgery and Liver Transplantation, APHP Beaujon Hospital, University of Paris Cité, Clichy, France.
¹¹ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
¹² Department of HPB Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
¹³ Department of Surgery, Regional Academic Cancer Centre Utrecht, UMC Utrecht Cancer Centre and St Antonius Hospital Nieuwegein, University Medical Centre Utrecht, Utrecht, The Netherlands.
¹⁴ Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
¹⁵ Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta, Ljubljana, Slovenia.
¹⁶ Department of HPB, Endocrine and Transplantation Surgery, University Hospital Antwerp, Edegem, Belgium and University of Antwerp, Wilrijk, Belgium.
¹⁷ Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
¹⁸ Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherland.
¹⁹ Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium.
²⁰ Department of Surgery, Maastricht University Medical Center+, University of Maastricht, Maastricht, The Netherlands.
²¹ Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
²² Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
²³ HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain.
²⁴ Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
²⁵ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
²⁶ Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.
²⁷ Department of HPB and Transplant Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
²⁸ Department of Surgery, Saint-Éloi Hospital, Montpellier, France.
²⁹ Department of Surgery, OLVG, Amsterdam, The Netherlands.
³⁰ Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
³¹ Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
³² Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³³ Department of Hepato, Pancreato, Biliary, and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

PMID: 38498397
PMCID: PMC11175778
DOI: 10.1097/JS9.0000000000001315

Abstract

Background: International guidelines recommend monitoring the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry.

Patients and methods: Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and high-risk groups.

Results: Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% ( P <0.001). RDP was associated with fewer grade 2 intraoperative events compared with LDP (9.6% vs. 16.8%, P <0.001), with longer operating time (238 vs. 201 min, P <0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P =0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P =0.344). Three high-risk groups were identified; BMI greater than 25 kg/m 2 , previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times.

Conclusion: This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with fewer conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.

Trial registration: ClinicalTrials.gov NCT06160154.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 1**
Use of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the period 2019-2021.

See this image and copyright information in PMC

References

1. Sánchez-Velázquez P, Muller X, Malleo G, et al. . Benchmarks in Pancreatic Surgery: a novel tool for unbiased outcome comparisons. Ann Surg 2019;270:211–218. - PubMed
1. Abu Hilal M, van Ramshorst TME, Boggi U, et al. . The Brescia internationally validated European guidelines on minimally invasive pancreatic surgery (EGUMIPS). Ann Surg 2024;279:45–57. - PMC - PubMed
1. Asbun HJ, Moekotte AL, Vissers FL, et al. . The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection. Ann Surg 2020;271:1–14. - PubMed
1. Bjornsson B, Larsson AL, Hjalmarsson C, et al. . Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial. Br J Surg 2020;107:1281–1288. - PubMed
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Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study

Collaborators

Affiliations

Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials