Objective: To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.
Methods: The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.
Results: The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.
Conclusion: This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.
目的: 通过单一手术团队大样本量机器人胰腺手术（RPS）深入论证手术安全性、可行性及优越性。
方法: 2011年11月~ 2017年9月解放军总医院刘荣手术团队共完成1010例RPS，前瞻性收集、回顾性分析相关临床资料。手术主要采用第三代达芬奇机器人手术系统完成。
结果: 全组手术中机器人胰十二指肠切除术417例、远端胰腺切除术428例、中段胰腺切除60例、胰腺肿瘤剜除术53例、Applyby3例、其他手术49例（包括创新性机器人后腹腔镜4例，肿瘤剜除联合主胰管架桥修复4例、单孔机器人胰腺肿瘤剜除术1例和中段胰腺切除联合端端对吻胰腺重建术2例）。中位手术时间210 min（30~720 min），中位术中出血量80 mL（10~2000 mL），中转率4.06%（41/1010），输血率6.7%（68/1010），术后住院时间10.87±6.70 d，Clavien-Dindo Ⅲ级以上并发症发生率8.0%（81/1010）、B级以上胰瘘发生率9.21%（93/1010），30 d死亡率0.69%（7/1010）、90 d死亡率1.31%（12/934）。RPS比例由2012年10.44%升至2017年72.06%。
结论: 本研究为目前全球最大宗RPS病例组报道，临床实践表明随着经验的积累和方法的优化，RPS能够得以发展快速，并逐渐取代开腹和腹腔镜手术，成为胰腺手术首选术式。经过学习曲线后，包括胰十二指肠切除术、Appleby在内的所有RPS安全、可行，早期开展RPS时应借鉴成熟经验以减少并发症发生。