November 18, 2010

Study: Robots Helpful in Complex Surgeries

(Ivanhoe Newswire)-- It's a high-tech takeover and some doctors are raving about robotic-assisted surgery involving complex pancreatic procedures.

Complex pancreatic surgery, without the assistance of robotics, presents two technical challenges: controlling bleeding from major blood vessels and reconstructing ducts in the liver and pancreas.

"Despite recent data suggesting that complex pancreatic operations can be performed laparoscopically at high-volume centers, the use of traditional laparoscopic instruments has required that critical technical principles of open pancreatic surgery be modified to overcome the limitations of current technology," authors of the study were quoted as saying.  "Examples include limited range of instrument motion, poor surgeon ergonomics, reliance on two-dimensional imaging and reduced dexterity."

Amer H. Zureikat, M.D., and colleagues at the University of Pittsburgh School of Medicine and Cancer Institute noted that robotic-assisted surgery may help to overcome some of these difficulties, allowing difficult pancreatic surgeries to be performed with safety and efficacy of open surgery but with the potential benefits of laparoscopic procedures.

In a study, 30 patients underwent robotic-assisted pancreatic resection (removal of part of organ) between October 2008 February 2010.

In the 90 days following the procedure there was one postoperative death.  Eight cases of pancreatic fistula, an opening between the pancreas and other organs, occurred; only three of which were clinically significant.  This rate is consistent with that observed in large groups of patients undergoing open procedures, the authors note.

Severe 90-day complications developed in seven patients (23 percent), while less severe complications occurred in eight patients (27 percent).  Two patients (7 percent) underwent reoperation.  According to the authors, these rates are similar to those reported among patients undergoing open procedure and compare favorably to those of minimally invasive procedures.

"Robotic-assisted pancreatic surgery continues to evolve, and newer technologies may reduce operative times by minimizing the time associated with docking the robot as well as loading and extracting needles from the abdomen," the authors write. "Although no specific complications (pneumonia or prolonged ventilator dependence) were attributed to long operative times in this cohort of patients, larger series of patients and shorter operative times may demonstrate the underlying benefits of robotic-assisted surgery more convincingly."

These include shorter hospital stays, fewer wound- and lung-related complications and decreased recovery time in the short term and reduced rates of hernia and bowel complications in the longer term.

SOURCE: JAMA and Archives Journals