Performance with robotic surgery versus 3D- and 2D­laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials

Maurice J.W. Zwart, Leia R. Jones*, for the Dutch Pancreatic Cancer Group, Ignacio Fuente, Alberto Balduzzi, Kosei Takagi, Stephanie Novak, Luna A. Stibbe, Thijs de Rooij, Jony van Hilst, L. Bengt van Rijssen, Susan van Dieren, Aude Vanlander, Peter B. van den Boezem, Freek Daams, J. Sven D. Mieog, Bert A. Bonsing, Camiel Rosman, Sebastiaan Festen, Misha D. LuyerDaan J. Lips, Arthur J. Moser, Olivier R. Busch, Mohammad Abu Hilal, Melissa E. Hogg, Luna A. Stibbe, Martijn W.J. Stommel, Marc G. Besselink

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Robotic surgery may improve surgical performance during minimally invasive pancreatoduodenectomy as compared to 3D- and 2D-laparoscopy but comparative studies are lacking. This study assessed the impact of robotic surgery versus 3D- and 2D-laparoscopy on surgical performance and operative time using a standardized biotissue model for pancreatico- and hepatico-jejunostomy using pooled data from two randomized controlled crossover trials (RCTs). Methods: Pooled analysis of data from two RCTs with 60 participants (36 surgeons, 24 residents) from 11 countries (December 2017–July 2019) was conducted. Each included participant completed two pancreatico- and two hepatico-jejunostomies in biotissue using 3D-robotic surgery, 3D-laparoscopy, or 2D-laparoscopy. Primary outcomes were the objective structured assessment of technical skills (OSATS: 12–60) rating, scored by observers blinded for 3D/2D and the operative time required to complete both anastomoses. Sensitivity analysis excluded participants with excess experience compared to others. Results: A total of 220 anastomoses were completed (robotic 80, 3D-laparoscopy 70, 2D­laparoscopy 70). Participants in the robotic group had less surgical experience [median 1 (0–2) versus 6 years (4–12), p < 0.001], as compared to the laparoscopic group. Robotic surgery resulted in higher OSATS ratings (50, 43, 39 points, p =.021 and p <.001) and shorter operative time (56.5, 65.0, 81.5 min, p =.055 and p <.001), as compared to 3D- and 2D­laparoscopy, respectively, which remained in the sensitivity analysis. Conclusion: In a pooled analysis of two RCTs in a biotissue model, robotic surgery resulted in better surgical performance scores and shorter operative time for biotissue pancreatic and biliary anastomoses, as compared to 3D- and 2D-laparoscopy.

Original languageEnglish
Pages (from-to)4518-4528
Number of pages11
JournalSurgical Endoscopy
Volume36
Issue number6
Early online date19 Nov 2019
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
Maurice J.W. Zwart and Marc G. Besselink received funding from the Amsterdam UMC for studies on safe implementation of robot-assisted and laparoscopic pancreatic surgery; funding from the Dutch Digestive Foundation (MLDS; Grant Number I16-05) for studies on the before mentioned topics; and funding from Intuitive (Grant Reference: Evidence-based implementation of robot-assisted pancreatoduodenectomy using simulation training, LAELAPS-3) for the nationwide Dutch LAELAPS-3 training program for robotic pancreatoduodenectomy. Leia R. Jones, Ignacio Fuente, Alberto Balduzzi, Kosei Takagi, Stephanie Novak, Luna A. Stibbe, Thijs de Rooij, Jony van Hilst, Bengt van Rijssen, Susan van Dieren, Aude Vanlander, Peter B. van den Boezem, Freek Daams, J. Sven D. Mieog, Bert A. Bonsing, Camiel Rosman, Sebastiaan Festen, Misha D. Luyer, Daan J. Lips, Arthur J. Moser, Melissa E. Hogg, Olivier R. Busch, Mohammad Abu Hilal, and Martijn W.J. Stommel have no conflict of interest or financial ties to disclose.

Publisher Copyright:
© 2021, The Author(s).

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