The safety and feasibility of robotic pancreaticoduodenectomy: A multicenter retrospective assessment of 425 patients in Japan

So Nakamura; Kohei Nakata; Yuichi Nagakawa; Shingo Kozono; Go Wakabayashi; Taiga Wakabayashi; Ichiro Uyama; Takeshi Takahara; Yutaka Takeda; Yoshiaki Ohmura; Saiho Ko; Ayumi Nishioka; Sho Kiritani; Yosuke Inoue; Tomohiko Adachi; Susumu Eguchi; Mamoru Morimoto; Yoichi Matsuo; Hiroshi Kurahara; Takao Ohtsuka; Masafumi Nakamura

doi:10.1002/jhbp.12101

The safety and feasibility of robotic pancreaticoduodenectomy: A multicenter retrospective assessment of 425 patients in Japan

J Hepatobiliary Pancreat Sci. 2024 Dec 23. doi: 10.1002/jhbp.12101. Online ahead of print.

Authors

So Nakamura¹, Kohei Nakata¹, Yuichi Nagakawa², Shingo Kozono², Go Wakabayashi³, Taiga Wakabayashi³, Ichiro Uyama⁴, Takeshi Takahara⁵, Yutaka Takeda⁶, Yoshiaki Ohmura⁶, Saiho Ko⁷, Ayumi Nishioka⁷, Sho Kiritani⁸, Yosuke Inoue⁸, Tomohiko Adachi⁹, Susumu Eguchi⁹, Mamoru Morimoto¹⁰, Yoichi Matsuo¹⁰, Hiroshi Kurahara¹¹, Takao Ohtsuka¹¹, Masafumi Nakamura¹

Affiliations

¹ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
³ Center for Advanced Treatment of Hepatobiliary and Pancreatic Disease, Ageo Central General Hospital, Saitama, Japan.
⁴ Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Aichi, Japan.
⁵ Department of Surgery, Fujita Health University, Aichi, Japan.
⁶ Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.
⁷ Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
⁸ Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
⁹ Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
¹⁰ Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
¹¹ Department of Digestive Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan.

PMID: 39711213
DOI: 10.1002/jhbp.12101

Abstract

Background/purpose: The Japanese public health insurance system has recently covered robotic pancreaticoduodenectomy (RPD). This study aimed to review the results of RPD during the introductory period and elucidate its safety and feasibility in Japan.

Methods: Consecutive data of 425 patients who underwent RPD were retrospectively collected from 10 high-volume centers in Japan between April 2020 and September 2022. The primary endpoints were the rates of conversion to open surgery and completion of minimally invasive surgery (MIS), defined as the use of a totally robotic operation or combined robotic and laparoscopic procedures. Secondary endpoints were operative time, blood loss, complication rate, and 30- and 90-day mortality rates.

Results: Study comprised 222 males and 203 females, with a median age of 70 (p10-p90; 50-81) years. The conversion to open surgery and completion rates of MIS were 3.8% (16 patients) and 91.1% (387 patients), respectively. The median operative time was 617 min (p10-p90; 456-834 min), and the median volume of blood loss was 160 g (p10-p90; 30-558 g). The complication rate (Clavien-Dindo classification grade ≥ IIIa) was 20.5%. The 30- and 90-day mortality rates were 0.2% and 0.5%, respectively.

Conclusions: Our results indicate that RPD can be introduced successfully and is a promising approach for pancreaticoduodenectomy.

Keywords: minimally invasive pancreaticoduodenectomy; minimally invasive surgery; robotic pancreaticoduodenectomy; robot‐assisted pancreaticoduodenectomy; robot‐assisted surgery.