Reduced port minimally invasive distal pancreatectomy: single-port laparoscopic versus robotic single-site plus one-port distal pancreatectomy

Background: Minimally invasive surgery appears to be developing in multiple directions, including single-port laparoscopic (SPL), single-port robotic, reduced port laparoscopic, or single-site plus one-port robotic approach. The aim of study was to compare the short-term perioperative variables and outcomes of patients undergoing reduced port minimally invasive distal pancreatectomy (DP) via the SPL, or robotic single-site plus one-port (RSS + 1) approach. Methods: The medical records of 35 patients were retrospectively reviewed, who underwent SPL-DP (n = 22) or RSS + 1 DP (n = 13) at Korea University Ansan Hospital and Yonsei University Severance Hospital. Results: The mean operation time in SPL group was significantly higher than that of RSS + 1 group (281 vs 192, p =.001). The mean blood loss in SPL was significantly larger than that of RSS + 1 group (163 vs 12, p =.002). The mean length of free resection margin in SPL group was significantly longer than that of RSS + 1 group (2.1 vs 0.4 cm, p =.001). Spleen was significantly preserved in SPL group (54.5 vs 7.7%, p =.001). All RSS + 1 cases had tumors located near spleen hilum (p <.001). SPL approach had significantly grade IIIa complications (p =.014). Moreover, the mean hospital stay in SPL group was significantly longer than that of RSS + 1 group (14.4 vs 7.4 days, p =.004). Postoperative pancreatic fistula (POPF) was significantly observed in longer operation time (p =.043) and smaller tumor size (p =.037) in the univariate analysis. Higher BMI was significantly important factor for prolonged operation time (p =.034) in the multivariate analysis. Prolonged hospital stay was related to spleen preservation (p =.014) in the multivariate analysis. Conclusions: Both SPL and RSS + 1 are technically feasible and safe. RSS + 1-DP is superior to SPL-DP in terms of operation time, blood loss, severe complications, and hospital stay. SPL-DP shows advantages in terms of single wound site, less trocar usage, higher rate of spleen preservation, and wider range of operative field.