The operative technique at our institution has been described in detail previously.[21 24 (link)27 (link)28 (link)] Briefly, robotic distal pancreatectomy was performed using three robotic arms (two left, one right) and a robotic camera system (Da Vinci Si, Intuitive Surgical, Sunnyvale, California, USA). The robotic instruments used included a combination of some of the following instruments: harmonic scalpel, Cadiere forceps, fenestrated bipolar, Hem-o-lok clip® applicator and a large needle driver. The bedside assistant used conventional laparoscopic suckers, bowel graspers and endostaplers through a 12-mm assistant port placed in the left iliac fossa.
LDP was performed using various laparoscopic energy devices over the study period depending on the individual surgeon preference including the harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). In general, dissection of the pancreas proceeded from the medial to the lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and in selected cases, these were reinforced with sutures.
LDP was performed using various laparoscopic energy devices over the study period depending on the individual surgeon preference including the harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). In general, dissection of the pancreas proceeded from the medial to the lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and in selected cases, these were reinforced with sutures.
