Robotic Pancreatoduodenectomy: Increasing Complexity and Decreasing Complications with Experience: Single‑Center Results from 150 Consecutive Patients

Objective: We present our experience with 150 consecutive robotic pancreatoduodenectomies.

Methods: 150 consecutive patients who underwent robotic pancreatoduodenectomy between 2018 and 2023 were included. Preoperative and intraoperative variables such as age, gender, indication, operation time, diagnosis, tumor size were analyzed. The patients were divided into two groups. Group 1 comprised the first 75 patients and group 2 comprised the last 75 cases. The median age of the patients was 62.4 years and did not differ between the two groups.

Results: Morbidity was lower in group 2. The mortality rate was 0.7% at 30 days and 1.3% at 90 days, and there was no difference between the groups. There was a significant (p < 0.05) reduction in operative time, resection time, reconstruction time and conversion to open surgery in group 2. Partial resection of the portal vein was performed in 17 patients and was more common in group 2 (p < 0.01). The number of resected lymph nodes was higher in group 2. There was no difference in the indication for pancreatoduodenectomy in the two groups. There was no difference in tumor size or clinical characteristics of the patients.

Conclusions: The robotic platform is useful for pancreatoduodenectomy, facilitates adequate lymphadenectomy, and is helpful for digestive tract reconstruction after resection. Robotic pancreatoduodenectomy is safe and feasible in selected patients. It should be performed in specialized centers by surgeons experienced in open and minimally invasive pancreatic surgery.