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Letter to the Editor
Laparoscopic and robotic distal pancreatectomy: the choice and the future
Francisco Espin Alvareza,
Corresponding author
fjespin.germanstrias@gencat.cat

Corresponding author.
, María Isabel García-Domingob, Manel Cremades Péreza, Esteban Cugat Andorraa,b
a Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
b Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">First of all&#44; the authors would like to thank you for your comments and the analysis of the article&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As it highlights&#44; the implementation or incorporation of the robotic platform must follow the surgical principles and must demonstrate its effectiveness&#44; efficiency&#44; and safety&#44; so we believe and so we raise it when analyzing our results&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In response to the questions raised&#46; We have not analyzed the degree of induced diabetes after distal pancreatectomy&#46; Our study assesses short-term outcomes&#46; We consider your comment and keep it in mind for future analysis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the perception and satisfaction of the patients&#44; as well as the functional recovery&#46; This analysis is a departure from the main objectives of the study&#44; and would in itself deserve to be presented in a single article&#46; Nevertheless&#44; we consider it elementary and have already incorporated it into the set of variables to be analyzed in daily clinical practice&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We have carefully reviewed the articles referenced in your letter&#46; We have not found a clear justification in both studies as they have not used a learning curve analysis methodology and both have some biases in this respect&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe&#44; and this has been our experience&#44; that the robotic platform shortens the learning curves&#46; As M&#252;ller et al&#46; reported&#44; the analysis of learning curves in literature is arbitrary in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the last years&#44; new literature has become available&#44; and robotic pancreatic surgery had a significant expansion&#46; Recently&#44; the internationally validated European guidelines on minimally Invasive Pancreatic Surgery proclaimed that the learning curves for robotic distal pancreatectomy are slightly shorter compared with a laparoscopic approach&#46; Apart from&#44; minimum center volumes and indications for minimally invasive surgery were the most debated topics&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Again&#44; we would like to thank you for your suggestions&#46;</p></span>"
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