Reduced port minimally invasive distal pancreatectomy: single-port laparoscopic versus robotic single-site plus one-port distal pancreatectomy

초록

BackgroundMinimally invasive surgery appears to be developing in multiple directions, including single-port laparoscopic (SPL), single-port robotic, reduced port laparoscopic, or single-site plus one-port robotic approach. The aim of study was to compare the short-term perioperative variables and outcomes of patients undergoing reduced port minimally invasive distal pancreatectomy (DP) via the SPL, or robotic single-site plus one-port (RSS+1) approach.MethodsThe medical records of 35 patients were retrospectively reviewed, who underwent SPL-DP (n=22) or RSS+1 DP (n=13) at Korea University Ansan Hospital and Yonsei University Severance Hospital.ResultsThe mean operation time in SPL group was significantly higher than that of RSS+1 group (281 vs 192, p=.001). The mean blood loss in SPL was significantly larger than that of RSS+1 group (163 vs 12, p=.002). The mean length of free resection margin in SPL group was significantly longer than that of RSS+1 group (2.1 vs 0.4cm, p=.001). Spleen was significantly preserved in SPL group (54.5 vs 7.7%, p=.001). All RSS+1 cases had tumors located near spleen hilum (p<.001). SPL approach had significantly grade IIIa complications (p=.014). Moreover, the mean hospital stay in SPL group was significantly longer than that of RSS+1 group (14.4 vs 7.4 days, p=.004). Postoperative pancreatic fistula (POPF) was significantly observed in longer operation time (p=.043) and smaller tumor size (p=.037) in the univariate analysis. Higher BMI was significantly important factor for prolonged operation time (p=.034) in the multivariate analysis. Prolonged hospital stay was related to spleen preservation (p=.014) in the multivariate analysis.ConclusionsBoth SPL and RSS+1 are technically feasible and safe. RSS+1-DP is superior to SPL-DP in terms of operation time, blood loss, severe complications, and hospital stay. SPL-DP shows advantages in terms of single wound site, less trocar usage, higher rate of spleen preservation, and wider range of operative field.

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