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Page 4 of 5 Addeo Mini-invasive Surg 2020;4:64 I http://dx.doi.org/10.20517/2574-1225.2020.47

Figure 1. PRISMA flow chart of study selection

during robotic PD. Since then, further studies have reported experience with this approach. This current
review found 140 PD with venous resection, of which 50% were performed robotically.

Most of these minimally invasive PDs with venous resection were lateral resections (58.5%), which needed
either direct suture-repair or patch-interposition. This is certainly related to less advanced cases operated by
MIS and to the challenges posed by segmental resection. Segmental resection is, in fact, needed more often
in case of long and circumferential venous involvement; can require extensive mesenteric mobilization
in order to achieve a tension-free venous approximation; and can require prolonged vascular clamping
which can cause bowel oedema impairing the endoscopic view. The largest series to date of robotic PD
[14]
[12]
with venous resection (50 cases) reported only one case of segmental resection , whereas Croome et al.
reported 9 over 22 cases of laparoscopic segmental venous resection.
Patch-repair was the technique of choice in case of a large defect of the lateral venous wall. Peritoneal,
bovine pericardium and polytetrafluoroethylene material were variably used for venous patches.
Postoperative thrombosis was rarely reported [3,15,17] . We found a 5.7% postoperative mortality rate which
is in the range of that reported in large registry studies in Europe [20,21] . The causes of mortality were not
different to those in open PD, with no specific complications related to the approach used. Blood loss and
operative time seem to be comparable to that reported for open surgery.

In conclusion, despite limited experience, the minimally invasive approach to PD with venous resection
seems feasible, with an acceptable rate of mortality and morbidity in the hands of highly experienced
pancreatic surgeons. The advantages of this approach over open surgery remain to be determined.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.