Minimally Invasive Distal Pancreatectomy: Are There Long-Term Benefits?

The immediate and long-term results of treatment of 30 patients with severe pain syndrome of the lumbar region, who underwent operations on denervation of DOS, were studied. The aim of the study was to evaluate the effectiveness of minimally invasive technologies for the treatment of pain in the lumbar region (denervation of DOS), to study the near and distant results of these treatment methods. Denervation DOS is an effective minimally invasive method for the treatment of facet syndrome caused by spondylarthrosis. It allows in the early and distant postoperative periods to significantly reduce the pain syndrome and improve the quality of life of patients.

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Minimally Invasive versus Open Distal Pancreatectomy: An Individual Patient Data Meta-Analysis of Two Randomized Controlled Trials

Pancreatology ◽

10.1016/j.pan.2020.07.365 ◽

2020 ◽

Vol 20 ◽

pp. S186

Author(s):

M. Korrel ◽

F. Vissers ◽

J. Van Hilst ◽

T. De Rooij ◽

M. Dijkgraaf ◽

...

Keyword(s):

Minimally Invasive ◽

Randomized Controlled Trials ◽

Distal Pancreatectomy ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Controlled Trials ◽

Randomized Controlled ◽

Open Distal Pancreatectomy

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Minimally invasive distal pancreatectomy: a case-matched cost-analysis between robot-assisted surgery and direct manual laparoscopy

Surgical Endoscopy ◽

10.1007/s00464-021-08332-1 ◽

2021 ◽

Author(s):

Gregorio Di Franco ◽

Andrea Peri ◽

Valentina Lorenzoni ◽

Matteo Palmeri ◽

Niccolò Furbetta ◽

...

Keyword(s):

Minimally Invasive ◽

Cost Analysis ◽

Distal Pancreatectomy ◽

Length Of Hospital Stay ◽

High Volume ◽

Fixed Costs ◽

Spleen Preservation ◽

Robotic Assisted Surgery ◽

The Mean ◽

Complications Rate

Abstract Background Few studies have reported a structured cost analysis of robotic distal pancreatectomy (RDP), and none have compared the relative costs between the robotic-assisted surgery (RAS) and the direct manual laparoscopy (DML) in this setting. The aim of the present study is to address this issue by comparing surgical outcomes and costs of RDP and laparoscopic distal pancreatectomies (LDP). Methods Eighty-eight RDP and 47 LDP performed between January 2008 and January 2020 were retrospectively analyzed. Three comparable groups of 35 patients each (Si-RDP-group, Xi-RDP group, LDP-group) were obtained matching 1:1 the RDP-groups with the LDP-group. Overall costs, including overall variable costs (OVC) and fixed costs were compared using generalized linear regression model adjusting for covariates. Results The conversion rate was significantly lower in the Si-RDP-group and Xi-RDP-group: 2.9% and 0%, respectively, versus 14.3% in the LDP-group (p = 0.045). Although not statistically significant, the mean operative time was lower in Xi-RDP-group: 226 min versus 262 min for Si-RDP-group and 247 min for LDP-group. The overall post-operative complications rate and the length of hospital stay (LOS) were not significantly different between the three groups. In LDP-group, the LOS of converted cases was significantly longer: 15.6 versus 9.8 days (p = 0.039). Overall costs of LDP-group were significantly lower than RDP-groups, (p < 0.001). At multivariate analysis OVC resulted no longer statistically significantly different between LDP-group and Xi-RDP-group (p = 0.099), and between LDP-group and the RDP-groups when the spleen preservation was indicated (p = 0.115 and p = 0.261 for Si-RDP-group and Xi-RDP-group, respectively). Conclusions RAS is more expensive than DML for DP because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs, in a high-volume multidisciplinary center for RAS, suggests a possible optimization of the costs in this setting. RAS might be particularly indicated for minimally invasive DP when the spleen preservation is scheduled.

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Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02113-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Mirhasan Rahimli ◽

Aristotelis Perrakis ◽

Vera Schellerer ◽

Andrew Gumbs ◽

Eric Lorenz ◽

...

Keyword(s):

Abdominal Surgery ◽

Minimally Invasive ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Long Term Outcomes ◽

Short Term ◽

Minimally Invasive Liver Surgery ◽

Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

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