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      Educational step-by-step surgical video about operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique—Lessons learned since the first worldwide RPD performed in the year 2001

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          Abstract

          Background

          RPD (Robotic pancreatoduodenectomy) was first performed by P. C. Giulianotti in 2001 (Arch Surg 138(7):777–784, 2003). Since then, the complexity and lack of technique standardization has slowed down its widespread utilization. RPD has been increasingly adopted worldwide and in few centres is the preferred apporached approach by certain surgeons. Some large retrospective series are available and data seem to indicate that RPD is safe/feasible, and a valid alternative to the classic open Whipple. Our group has recently described a standardized 17 steps approach to RPD (Giulianotti et al. Surg Endosc 32(10): 4329–4336, 2018). Herin, we present an educational step-by-step surgical video with short technical/operative description to visually exemplify the RPD 17 steps technique.

          Methods

          The current project has been approved by our local Institutional Review Board (IRB). We edited a step-by-step video guidance of our RPD standardized technique. The data/video images were collected from a retrospective analysis of a prospectively collected database (IRB approved). The narration and the images describe hands-on operative “tips and tricks” to facilitate the learning/teaching/evaluation process.

          Results

          Each of the 17 surgical steps is visually represented and explained to help the in-depth understanding of the relevant surgical anatomy and the specific operative technique.

          Conclusions

          Educational videos descriptions like the one herein presented are a valid learning/teaching tool to implement standardized surgical approaches. Standardization is a crucial component of the learning curve. This approach can create more objective and reproducible data which might be more reliably assessed/compared across institutions and by different surgeons. Promising results are arising from several centers about RPD. However, RPD as gold standard-approach is still a matter of debate. Randomized-controlled studies (RCT) are required to better validate the precise role of RPD.

          Electronic supplementary material

          The online version of this article (10.1007/s00464-020-07383-0) contains supplementary material, which is available to authorized users.

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          Most cited references6

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          Minimally invasive versus open pancreatoduodenectomy—systematic review and meta-analysis

          Purpose The purpose of this systematic review was to compare minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) by using meta-analytical techniques. Methodology Medline, Embase, and Cochrane Library were searched for eligible studies. Data from included studies were extracted for the following outcomes: operative time, overall morbidity, pancreatic fistula, delayed gastric emptying, blood loss, postoperative hemorrhage, yield of harvested lymph nodes, R1 rate, length of hospital stay, and readmissions. Random and fix effect meta-analyses were undertaken. Results Initial reference search yielded 747 articles. Thorough evaluation resulted in 12 papers, which were analyzed. The total number of patients was 2186 (705 in MIPD group and 1481 in OPD). Although there were no differences in overall morbidity between groups, we noticed reduced blood loss, delayed gastric emptying, and length of hospital stay in favor of MIPD. In contrary, meta-analysis of operative time revealed significant differences in favor of open procedures. Remaining parameters did not differ among groups. Conclusion Our review suggests that although MIPD takes longer, it may be associated with reduced blood loss, shortened LOS, and comparable rate of perioperative complications. Due to heterogeneity of included studies and differences in baseline characteristics between analyzed groups, the analysis of short-term oncological outcomes does not allow drawing unequivocal conclusions. Electronic supplementary material The online version of this article (doi:10.1007/s00423-017-1583-8) contains supplementary material, which is available to authorized users.
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            Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors.

            Limited involvement of the major peripancreatic vessels is no longer considered a contraindication for resection in cases of locally advanced pancreatic cancer. Extended open pancreatectomies associated with vascular resection are performed in experienced centers with mortality and morbidity rates comparable to standard pancreatic resection. We evaluate the safety, feasibility, and outcomes of robotic extended pancreatectomy with vascular resection.
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              Total robotic pancreaticoduodenectomy: a systematic review of the literature.

              Pancreaticoduodenectomy (PD) is a complex operation with high perioperative morbidity and mortality, even in the highest volume centers. Since the development of the robotic platform, the number of reports on robotic-assisted pancreatic surgery has been on the rise. This article reviews the current state of completely robotic PD.
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                Author and article information

                Contributors
                alberto.mangano@gmail.com
                Journal
                Surg Endosc
                Surg Endosc
                Surgical Endoscopy
                Springer US (New York )
                0930-2794
                1432-2218
                17 January 2020
                17 January 2020
                2020
                : 34
                : 6
                : 2758-2762
                Affiliations
                GRID grid.185648.6, ISNI 0000 0001 2175 0319, Division of General, Minimally Invasive and Robotic Surgery, , University of Illinois at Chicago, ; 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL 60612 USA
                Author information
                http://orcid.org/0000-0003-4671-6453
                Article
                7383
                10.1007/s00464-020-07383-0
                7214390
                31953732
                6c9cd1f3-4f2d-4abd-8835-15f1c832ec04
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 26 August 2019
                : 7 January 2020
                Categories
                Dynamic Manuscript
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                Surgery
                robotic pancreatoduodenectomy,whipple procedure,evidence based surgery,pancreatic surgery,pancreatic cancer,minimally invasive surgery

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