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3. Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

Author

Emmen, Anouk M.L.H., Görgec, B., Zwart, M. J.W., Daams, F., Erdmann, J., Festen, S., Gouma, D. J., van Gulik, T. M., van Hilst, J., Kazemier, G., Lof, S., Sussenbach, S. I., Tanis, P. J., Zonderhuis, B. M., Busch, O. R., Swijnenburg, R. J., Besselink, M. G., Emmen, Anouk M.L.H., Görgec, B., Zwart, M. J.W., Daams, F., Erdmann, J., Festen, S., Gouma, D. J., van Gulik, T. M., van Hilst, J., Kazemier, G., Lof, S., Sussenbach, S. I., Tanis, P. J., Zonderhuis, B. M., Busch, O. R., Swijnenburg, R. J., and Besselink, M. G.

Abstract

Background: Many centers worldwide are shifting from laparoscopic to robotic minimally invasive hepato-pancreato-biliary resections (MIS-HPB) but large single center series assessing this process are lacking. We hypothesized that the introduction of robot-assisted surgery was safe and feasible in a high-volume center. Methods: Single center, post-hoc assessment of prospectively collected data including all consecutive MIS-HPB resections (January 2010–February 2022). As of December 2018, all MIS pancreatoduodenectomy and liver resections were robot-assisted. All surgeons had participated in dedicated training programs for laparoscopic and robotic MIS-HPB. Primary outcomes were in-hospital/30-day mortality and Clavien-Dindo ≥ 3 complications. Results: Among 1875 pancreatic and liver resections, 600 (32%) were MIS-HPB resections. The overall rate of conversion was 4.3%, Clavien-Dindo ≥ 3 complications 25.7%, and in-hospital/30-day mortality 1.8% (n = 11). When comparing the period before and after the introduction of robotic MIS-HPB (Dec 2018), the overall use of MIS-HPB increased from 25.3 to 43.8% (P < 0.001) and blood loss decreased from 250 ml [IQR 100–500] to 150 ml [IQR 50–300] (P < 0.001). The 291 MIS pancreatic resections included 163 MIS pancreatoduodenectomies (52 laparoscopic, 111 robotic) with 4.3% conversion rate. The implementation of robotic pancreatoduodenectomy was associated with reduced operation time (450 vs 361 min; P < 0.001), reduced blood loss (350 vs 200 ml; P < 0.001), and a decreased rate of delayed gastric emptying (28.8% vs 9.9%; P = 0.009). The 309 MIS liver resections included 198 laparoscopic and 111 robotic procedures with a 3.6% conversion rate. The implementation of robotic liver resection was associated with less overall complications (24.7% vs 10.8%; P = 0.003) and shorter hospital stay (4 vs 3 days; P < 0.001). Conclusion: The introduction of robotic surgery was associated with greater implementation of MIS-HPB in

Published
2023

4. 27.1 Icterus

Author

Gouma, D. J., Bonjer, H. J., editor, Aronson, D. C., editor, Blankensteijn, J. D., editor, Gooszen, H. G., editor, Gouma, D. J., editor, Kroon, B. B. R., editor, and van Vugt, A. B., editor

Published
2005
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5. Inleiding

Author

Bonjer, H. J., Aronson, D. C., Blankensteijn, J. D., Gooszen, H. G., Gouma, D. J., Kroon, B. B. R., van Vugt, A. B., Bonjer, H. J., editor, Aronson, D. C., editor, Blankensteijn, J. D., editor, Gooszen, H. G., editor, Gouma, D. J., editor, Kroon, B. B. R., editor, and van Vugt, A. B., editor

Published
2005
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10. Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

Author

Emmen, Anouk. M. L. H., Görgec, B., Zwart, M. J. W., Daams, F., Erdmann, J., Festen, S., Gouma, D. J., van Gulik, T. M., van Hilst, J., Kazemier, G., Lof, S., Sussenbach, S. I., Tanis, P. J., Zonderhuis, B. M., Busch, O. R., Swijnenburg, R. J., Besselink, M. G., Graduate School, Radiology and Nuclear Medicine, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer biology and immunology, and CCA - Imaging and biomarkers

Subjects
Pancreatoduodenectomy, Distal pancreatectomy, Minimally invasive, Liver surgery
Abstract

Background: Many centers worldwide are shifting from laparoscopic to robotic minimally invasive hepato-pancreato-biliary resections (MIS-HPB) but large single center series assessing this process are lacking. We hypothesized that the introduction of robot-assisted surgery was safe and feasible in a high-volume center. Methods: Single center, post-hoc assessment of prospectively collected data including all consecutive MIS-HPB resections (January 2010–February 2022). As of December 2018, all MIS pancreatoduodenectomy and liver resections were robot-assisted. All surgeons had participated in dedicated training programs for laparoscopic and robotic MIS-HPB. Primary outcomes were in-hospital/30-day mortality and Clavien-Dindo ≥ 3 complications. Results: Among 1875 pancreatic and liver resections, 600 (32%) were MIS-HPB resections. The overall rate of conversion was 4.3%, Clavien-Dindo ≥ 3 complications 25.7%, and in-hospital/30-day mortality 1.8% (n = 11). When comparing the period before and after the introduction of robotic MIS-HPB (Dec 2018), the overall use of MIS-HPB increased from 25.3 to 43.8% (P < 0.001) and blood loss decreased from 250 ml [IQR 100–500] to 150 ml [IQR 50–300] (P < 0.001). The 291 MIS pancreatic resections included 163 MIS pancreatoduodenectomies (52 laparoscopic, 111 robotic) with 4.3% conversion rate. The implementation of robotic pancreatoduodenectomy was associated with reduced operation time (450 vs 361 min; P < 0.001), reduced blood loss (350 vs 200 ml; P < 0.001), and a decreased rate of delayed gastric emptying (28.8% vs 9.9%; P = 0.009). The 309 MIS liver resections included 198 laparoscopic and 111 robotic procedures with a 3.6% conversion rate. The implementation of robotic liver resection was associated with less overall complications (24.7% vs 10.8%; P = 0.003) and shorter hospital stay (4 vs 3 days; P < 0.001). Conclusion: The introduction of robotic surgery was associated with greater implementation of MIS-HPB in up to nearly half of all pancreatic and liver resections. Although mortality and major morbidity were not affected, robotic surgery was associated with improvements in some selected outcomes. Ultimately, randomized studies and high-quality registries should determine its added value. Graphical Abstract: [Figure not available: see fulltext.]

Published
2022

20. Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study)

Author

Bartels, S. A. L., Vlug, M. S., Hollmann, M. W., Dijkgraaf, M. G. W., Ubbink, D. T., Cense, H. A., van Wagensveld, B. A., Engel, A. F., Gerhards, M. F., Bemelman, W. A., Cuesta, M. A., van Geloven, A. A. W., van der Zaag, E. S., Wind, J., Preckel, B., Bossuyt, P., Gouma, D., Sprangers, M., van Berge Henegouwen, M. I., Tanis, P. J., Buskens, C. J., van Lenthe, Picard I., Bakker, C., DeJong, C. H., van Dam, R. M., van der Peet, D., van Zalingen, E., Noordhuis, A., Goei, T. H., van Tets, W., deWit, L., Clevers, W., Bieleman, A., Coenen, L., Bonekamp, E., van Abeelen, J., van Iterson-de Jong, D., and Krombeen, M.

Published
2014
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