Robotic hysterectomy: A review of indications, technique, outcome, and compli...
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
1. Innovative Surgical Techniques
in Hepatobiliary and Pancreatic
Surgery
Iswanto Sucandy, MD
Sharona Ross, MD
Alexander Rosemurgy, MD
Advanced Foregut and HepatoPancreatoBiliary Surgery
Florida Hospital Tampa
3. Minimally Invasive Surgery
Laparoscopic Surgery
Robotic Surgery
Robotic Pancreatic Resection (Distal pancreatectomy and Whipple)
Robotic Liver Resection (Major and Minor Hepatectomy)
Robotic Biliary Tract Resection and Reconstruction
4. Minimally Invasive Surgery
Started with laparoscopic cholecystectomy in 1990
Surgery with “ small incisions “
Advantages of minimally invasive surgery over traditional open surgery
Faster postoperative recovery
Shorter duration of hospital stay
Less pain - > less narcotic use
Less postoperative intestinal ileus
Less surgical site infection
Less postoperative hernia rate
Better cosmesis
Equal oncologic outcomes and survivals
5. Minimally Invasive Surgery
Laparoscopic versus Robotic operation
Robotic surgery is developed to overcome limitations of traditional laparoscopic
surgery
Application of Robotic surgery in complex major operations is most suitable
Hepatobiliary and Pancreatic surgery is the most technically complex/challenging
of all abdominal operations
7. Advantages of Robotic over Traditional
Laparoscopic Surgery
7 degrees of wrist motion – lower conversion rate
More precise dissections (key for complex Hepatobiliary and Pancreas operations)
High definition robotic camera (superior 3D visualization)
Tremor filtering
3 working arms at once
Elimination of excessive abdominal wall torque (especially in obese patients)
More ergonomic for operating surgeon
10. Robotic Pancreatic Surgery
A. Robotic distal pancreatectomy - pancreatic tumor in neck/midbody/tail
B. Robotic Whipple (pancreaticoduodenectomy) - pancreatic head, distal bile duct, or
duodenal tumors
Rapid recovery with shorter hospitals stay (average 5 days) especially with
enhanced recovery program after surgery
Minimal postoperative pain and narcotic use
15. A Multi-institutional Comparison of Perioperative Outcomes of
Robotic and Open Pancreaticoduodenectomy
Zureikat et al. Ann Surg. 2016 Oct;264(4):640-9
1028 patients from 8 major HPB centers
4.7 % conversion rate
Robotic Pancreaticoduodenectomy :
Reduced blood loss ( - 181 ml )
Reduced major complications (Odds ratio o.6)
Similar 90-day mortality
Similar oncologic outcomes R0 resection
Similar postoperative pancreatic fistula rate
Similar length of stay and readmission rate
17. Robotic Liver Surgery
Most common indications : Primary and Metastatic Liver Tumors
Most common procedures :
Robotic non-anatomical liver resection - “wedges”
Robotic Left or Right hemihepatectomy
Robotic formal sectionectomy (removing 2 liver segments)
Robotic cystic mass liver resection
18. Robotic Liver Surgery
Key Aspects :
Tumor location (periphery versus central / high segment 7-8 lesions)
Viccinity to the vital structures (inflow-outflow-biliary drainage)
Tumor size
Experience of robotic team (surgeon + OR team)
Experience of anesthesia team (low CVP < 5mmhg)
26. Robotic Biliary Tract Resection & Reconstruction
First report of laparoscopic choledochal cyst excision 1995 by Farello et al.
Technically difficult -- > slow adoption
Robotic choledochal cyst excision and RY reconstruction – A case series of 27
patients in 2014.
Robotic approach is gaining popularity due to technical ease of performing bilio-
enteric anastomosis
28. Innovative Surgical Techniques in Hepatobiliary
and Pancreatic Surgery
Advanced Foregut and HepatoPancreatoBiliary Surgery
Florida Hospital Tampa – Robotic HPB Program
Referral : 3000 Medical Park Dr, Suite 500, Tampa, FL 33613
Office Phone: (813) 615-7030
Fax: (813) 615-8350