International Expert Consensus on Precision Anatomy for Minimally Invasive Distal Pancreatectomy: PAM‐HBP Surgery Project

2021 ◽  
Author(s):  
Daisuke Ban ◽  
Hitoe Nishino ◽  
Takao Ohtsuka ◽  
Yuichi Nagakawa ◽  
Mohammed Abu Hilal ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Distal Pancreatectomy ◽  
Expert Consensus ◽  
International Expert

scholarly journals Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A-OSATS score

2021 ◽  
Author(s):  
Mona W. Schmidt ◽  
Caelan M. Haney ◽  
Karl-Friedrich Kowalewski ◽  
Vasile V. Bintintan ◽  
Mohammed Abu Hilal ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Patient Outcomes ◽  
Technical Skills ◽  
Expert Consensus ◽  
Global Rating Scale ◽  
Global Rating ◽  
Validity Evidence ◽  
International Expert ◽  
Live Animal ◽  
Intestinal Anastomoses

Abstract Introduction The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS). Materials and methods The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8). Results The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807–0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923–0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale. Conclusion With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.

scholarly journals Minimally invasive distal pancreatectomy: a case-matched cost-analysis between robot-assisted surgery and direct manual laparoscopy

2021 ◽  
Author(s):  
Gregorio Di Franco ◽  
Andrea Peri ◽  
Valentina Lorenzoni ◽  
Matteo Palmeri ◽  
Niccolò Furbetta ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cost Analysis ◽  
Distal Pancreatectomy ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Fixed Costs ◽  
Spleen Preservation ◽  
Robotic Assisted Surgery ◽  
The Mean ◽  
Complications Rate

Abstract Background Few studies have reported a structured cost analysis of robotic distal pancreatectomy (RDP), and none have compared the relative costs between the robotic-assisted surgery (RAS) and the direct manual laparoscopy (DML) in this setting. The aim of the present study is to address this issue by comparing surgical outcomes and costs of RDP and laparoscopic distal pancreatectomies (LDP). Methods Eighty-eight RDP and 47 LDP performed between January 2008 and January 2020 were retrospectively analyzed. Three comparable groups of 35 patients each (Si-RDP-group, Xi-RDP group, LDP-group) were obtained matching 1:1 the RDP-groups with the LDP-group. Overall costs, including overall variable costs (OVC) and fixed costs were compared using generalized linear regression model adjusting for covariates. Results The conversion rate was significantly lower in the Si-RDP-group and Xi-RDP-group: 2.9% and 0%, respectively, versus 14.3% in the LDP-group (p = 0.045). Although not statistically significant, the mean operative time was lower in Xi-RDP-group: 226 min versus 262 min for Si-RDP-group and 247 min for LDP-group. The overall post-operative complications rate and the length of hospital stay (LOS) were not significantly different between the three groups. In LDP-group, the LOS of converted cases was significantly longer: 15.6 versus 9.8 days (p = 0.039). Overall costs of LDP-group were significantly lower than RDP-groups, (p < 0.001). At multivariate analysis OVC resulted no longer statistically significantly different between LDP-group and Xi-RDP-group (p = 0.099), and between LDP-group and the RDP-groups when the spleen preservation was indicated (p = 0.115 and p = 0.261 for Si-RDP-group and Xi-RDP-group, respectively). Conclusions RAS is more expensive than DML for DP because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs, in a high-volume multidisciplinary center for RAS, suggests a possible optimization of the costs in this setting. RAS might be particularly indicated for minimally invasive DP when the spleen preservation is scheduled.

Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review

2021 ◽  
Author(s):  
Hitoe Nishino ◽  
Giuseppe Zimmitti ◽  
Takao Ohtsuka ◽  
Mohammed Abu Hilal ◽  
Brian K. P. Goh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Distal Pancreatectomy ◽  
Vascular Anatomy

scholarly journals Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma

HPB ◽  
2017 ◽  
Vol 19 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Anastasia Plotkin ◽  
Eugene P. Ceppa ◽  
Ben L. Zarzaur ◽  
Elizabeth M. Kilbane ◽  
Taylor S. Riall ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Distal Pancreatectomy ◽  
Pancreatic Adenocarcinoma
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