Development Of Minimally-Invasive Pancreaticoduodenectomy

Objective:To compare robotic pancreaticoduodenectomy(RPD)and open pancreaticoduodenectomy(OPD),laparoscopic pancreaticoduodenectomy(LPD)and OPD by two meta analyzation.Methods:RPD VS OPD:PubMed,EMBASE and Cochrane Library(till July 31,2015)were searched electronically,and traced related references.We used the terms:("robotic*" or "robot-assisted")and("pancreaticoduodenectomy" or"pancreatic surgery").All the articles comparing robotic pancreaticoduodenectomy with open pancreaticoduodenectomy were collected.The data were analyzed by the Cochrane network RevMan 5.3 software.LPD VS RPD:We searched electronic databases(PubMed,EMBASE and Cochrane Library)between 1992 and April 20,2016.The search term was designed as:("pancreaticoduodenectomy" or"duodenopancreatectomy")AND(laparoscop*or robot*).All the result and their related references were screened by two reviewers.Finally,we included 10 articles.After collecting data,Stata 14.0 was use to analyze the data.Results:For the group of RPD VS OPD,the meta-analysis showed no significant differences in pancreatic fistula and morbidity.RPD need more operative time than OPD,but not significantly(P=0.05).No significant differences in reoperation rate,but RPD has less hospital stays(P<0.00001)and higher R0 resection rate(P=0.04).Mean lymph node harvested has no significant differences between the groups(P=0.37).For the RPD VS OPD group,the net meta analyze showed as following.Intraoperative assessment:we gave up using this method to analyze the operation time for its high heterogeneity.No significant differences in conversion to open laparotomy(P>0.5).Pathology assessment:LPD and RPD had the equal RO resection,re-operation rate and lymph node harvest.Postoperative assessment:No significant di:fferences in morbidity,sever morbidity,pancreatic fistula and mortality between the two groups.But RPD showed less hospital stay than LPD.Conclusion:RPD has advantages over OPD,but no significant variation was found between LPD and RPD except for longer hospital stay.These two surgical method could be used in pancreaticoduodenectomy safely and effectivity.To reach a more objective conclusion,more data were needed.