Are Robots Safe in Pancreatic Surgery?

Though computer-assisted robotic technology is currently being utilized for a variety of pancreatic resections, it's very complex and often difficult to implement and characterize - which begs the question: Is it safe?

Surgeons who perform abdominal procedures have been using computer-assisted robotic techniques to address complex resections and anastomotic reconstructions in minimally-invasive manners. Though the technology is currently being utilized for a variety of pancreatic resections, it’s very complex and often difficult to implement and characterize — which begs the question: Is it safe?

To answer that question, a research team reviewed all robotic pancreatic procedures completed at the University of Pittsburgh retrospectively. For that review, data recorded on 250 consecutive robotic pancreatic resections performed between August 2008 and November 2012 was retrieved from a prospectively maintained database and assessed for safety, feasibility, versatility, and reliability.

Pancreaticoduodenectomy and distal pancreatectomy were the most common procedures performed, while central pancreatectomy, pancreatic enucleation, total pancreatectomy, Appleby resection, and Frey procedure were performed far less frequently, according to the data.

The researchers found that 30-day and 90-day mortality rates in the entire patient cohort were 0.8 percent and 2 percent, respectively. Rates of complications with Clavien scores of 3 and 4 were 14 percent and 6 percent, and approximately 4 percent of patients developed fistulas of grade C or above.

Mean operative times were 529 ± 103 minutes for pancreaticoduodenectomy and 257 ± 93 minutes for distal pancreatectomy. The researchers were able to identify continuous improvement in operative times over the approximately four years of data they reviewed.

Six percent of patients needed conversion to open procedure as a result of bleeding or failure to progress.

Though the review covered a large series of robotic pancreatic resections, the researchers didn’t identify any risks inherent to the new technology, as 30-day and 90-day morbidity were far below the national average of 3 to 5 percent. Thus, the authors concluded that robotic technology is just as safe and feasible as laparoscopic and open platforms.