Robotic Distal Pancreatectomy outperforms Laparoscopic Distal Pancreatectomy

A recent systematic review and meta-analysis found that Robotic distal pancreatectomy (RDP) has outperformed laparoscopic distal pancreatectomy (LDP) as a promising perioperative safety and feasibility technique. The study results were published in the journal Updates in Surgery.

Robotic surgery has many advantages like three-dimensional visualization, tremor filtration, motion scaling, and better ergonomics and hence it is becoming a promising surgical method in minimally invasive pancreatic surgery. Several studies explored the benefits of RDP over LDP regarding its perioperative safety and feasibility, but no consensus has been achieved yet. Hence researchers aimed to evaluate the benefits and drawbacks of RDP and LDP for perioperative outcomes. 

All studies comparing RDP to LDP in the PubMed, Embase, and the Cochrane Library database were systematically reviewed by June 2022. Fix or random-effects models were used according to the heterogeneity, for the meta-analysis of perioperative outcomes. Odds ratio (OR) weighted mean differences (WMD), and 95% confidence intervals (CI) were calculated. Any potential sources of high heterogeneity were explored by sensitivity. To evaluate the impact of publication bias on the pooled results a trim and fill analysis was used.

Findings:

• Thirty-four studies met the inclusion criteria.
• RDP was found to show higher benefits than LDP for higher spleen preservation and the Kimura method in benign and low-grade malignant tumors.
• Despite its cost, the frequency of RDP cases converting to laparotomy is low, and RDP has the added advantage of shorter postoperative hospital stays.
• Regarding the postoperative complications, RDP and LDP showed similar results except for 30-day mortality (RDP versus LDP, 0.1% versus 1.0%, p = 0.03). 

RDP is a safe, technologically feasible technique and outperformed LDP on perioperative outcomes despite the cost.  

Further reading: Li, P., Zhang, H., Chen, L. et al. Robotic versus laparoscopic distal pancreatectomy on perioperative outcomes: a systematic review and meta-analysis. Updates Surg (2022). https://doi.org/10.1007/s13304-022-01413-3