Jung JP, et al. - Whether technical variables during robotic pancreaticoduodenectomy (RPD) are associated with postoperative delayed gastric emptying (DGE), was investigated. Researchers reviewed video obtained at the time of operation and examined modifiable technical factors. In this study, they have mentioned the ways by which the incidence of DGE may be attenuated via surgical construction of the gastrojejunal anastomosis during RPD. The identified technical variables that were related to postoperative delayed gastric emptying were the angle of the gastrojejunal anastomosis, gastrostomy size, and surgical device style of gastrojejunal anastomosis.

Methods

• Technical assessment performed in all available videos (n=192) of consecutive RPDs performed at a single academic institution from October 3, 2008, through September 27, 2016, was retrospectively studied.
• Researchers reviewed video of gastrojejunal anastomosis during RPD.
• They classified delayed gastric emptying according to International Study Group of Pancreatic Surgery criteria.
• Video analysis was carried out to review technical variables specific in the construction of the gastrojejunal anastomosis.
• They correlated DGE with known patient variables and technical variables, individually and combined, using multivariate analysis.

Results

• A total of 410 RPDs were performed.
• According to data, video was available for 192 RPDs (80 women and 112 men; mean [SD] age, 65.7 [11.1] years).
• In 41 patients, the occurrence of delayed gastric emptying was reported (21.4%; grade A, 15; grade B, 14; and grade C, 12).
• On multivariate analysis, the following patient variables were found to be contributing to DGE: advanced age (odds ratio [OR] 1.11; 95% CI, 1.05-1.16; P<.001), small pancreatic duct size (OR, 0.84; 95% CI, 0.72-0.98; P=.03), and postoperative pseudoaneurysm (OR, 17.29; 95% CI, 2.34-127.78; P=.005).
• However, multivariate analysis revealed the following technical variables to be contributor to decreased DGE: the flow angle (within 30° of vertical) between the stomach and efferent jejunal limb (OR, 0.25; 95% CI, 0.08-0.79; P=.02), greater length of the gastrojejunal anastomosis (OR, 0.40; 95% CI, 0.20-0.77; P=.006), and a robotic-sewn anastomosis (robotic suture vs stapler: OR, 0.30; 95% CI, 0.09-0.95; P=.04).