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J.Jpn. Surg. Soc.. 123(5): 390-396, 2022
EVIDENCE FOR ROBOTIC-ASSISTED PANCREATIC SURGERY
Robotic-assisted pancreatic surgery (RAPS) has been covered by Japanese insurance since April 2020 and is being introduced mainly in high-volume centers. This article discusses the role of RAPS based on the latest evidence.
Using PubMed and EMBASE, we searched for English articles comparing perioperative outcomes (operation time, blood loss, open conversion, complications, pancreatic fistula, length of stay) of robotic-assisted pancreaticoduodenectomy (RPD) and distal pancreatectomy (RDP) with those of laparoscopic or open surgery (OPD/LPD and ODP/LDP).
RPD is associated with less blood loss and a shorter length of hospital stay compared with OPD, and a lower conversion rate compared with LPD. The postoperative complication rates are similar. RDP has a lower conversion rate and a higher success rate of spleen-preserving distal pancreatectomy compared with LDP. The operative time and postoperative complication rates are comparable among these approaches.
Low conversion rates of RAPS suggest that it can be used to handle more difficult cases. On the other hand, no studies have shown a decrease in postoperative complication rates, including pancreatic fistula. Further improvement of surgical techniques that take advantage of robotic surgery is desirable.
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