TABLE 3.
Domain 4 Procedures; Questions and Recommendations on Laparoscopic (L), Robotic (R), and General (G) MIPS
| Clinical questions (CQs) | Recommendation (R) | Evidence level | Form of recommendation | |
|---|---|---|---|---|
| Topic 7: Pancreatoduodenectomy | ||||
| L17 | What is the preferred anastomosis technique in LPD? | There is insufficient evidence to define a superior anastomotic technique during LPD. The choice of anastomosis during LPD is the surgeon’s preference. | Expert opinion | Weak |
| R17 | What is the preferred anastomosis technique in RPD? | There is insufficient evidence to define a superior anastomotic technique during RPD. The choice of anastomosis during RPD is the surgeon’s preference. | Expert opinion | Weak |
| Topic 8: Distal Pancreatectomy | ||||
| L18 | What are the recommendations on LS for the different spleen-preserving techniques? | In laparoscopic spleen preserving distal pancreatectomy, both vessel-sparing and vessel-resecting techniques are appropriate alternatives for the treatment of benign and premalignant diseases. | Low | Strong (upgraded by experts) |
| R18 | What are the recommendations on RAS for the different spleen-preserving techniques? | In robot-assisted spleen-preserving distal pancreatectomy, both vessel-sparing and vessel-resecting techniques are appropriate alternatives for the treatment of benign and premalignant diseases. | Low | Strong (upgraded by experts) |
| Topic 9: Parenchymal-sparing | ||||
| L19 | What is the role of LS in central pancreatectomy, regardless of indication? | The role of LS in central pancreatectomy has yet to be determined. Future studies are recommended. | Low | Strong |
| R19 | What is the role of RAS in central pancreatectomy, regardless of indication? | The role of RAS in central pancreatectomy has yet to be determined. Future studies are recommended. | Low | Strong |
| L20 | What is the role of LS in enucleation? | Laparoscopic enucleation of pancreatic lesions in selected patients should be considered as an appropriate alternative to open enucleation. | Moderate | Strong (upgraded by experts) |
| R20 | What is the role of RAS in enucleation? | Robot-assisted enucleation of pancreatic lesions in selected patients should be considered as an appropriate alternative to open enucleation. | Moderate | Strong (upgraded by experts) |
| Topic 10: Total Pancreatectomy | ||||
| L21 | What is the role of LS in total pancreatectomy, taking into account different indications? | Laparoscopic total pancreatectomy is an alternative approach to open total pancreatectomy when performed in selected patients by experienced surgeons in high-volume centers. | Low | Weak |
| R21 | What is the role of RAS in total pancreatectomy, taking into account different indications? | Robot-assisted total pancreatectomy is an alternative approach to open total pancreatectomy when performed in selected patients by experienced surgeons in high-volume centers. | Low | Weak |
LPD indicates laparoscopic pancreatoduodenectomy; LS, laparoscopic surgery; MIPS, minimally invasive pancreatic surgery; RAS, robot-assisted surgery; RPD, robot-assisted pancreatoduodenectomy.