Robotic pancreatoduodenectomy - how I do it: tips, tricks and pitfalls to standardize the technique to reduce postoperative morbidity and mortality

Abstract

Pancreatoduodenectomy (PD) is increasingly performed laparoscopically (LPD) and robotically (RPD) with the benefits of minimally invasive surgery and equivalent oncological outcomes compared with conventional open PD (OPD). When LPD and RPD are compared, RPD offers better precision with 3D vision and advanced instrumentation. Although the learning curve for RPD is long with a longer operating time compared with OPD, this can be reduced to a duration similar to that for OPD through standardization of techniques and case numbers. Perioperative outcomes such as length of stay, blood loss, and transfusion requirement are significantly improved compared to OPD and fewer cases require conversion to open than LPD. In this article, we describe our approach to RPD through standardizing PD techniques along with tips and tricks for the benefit of surgeons interested in learning robotic pancreatic surgery.

Keywords

Whipple’s / PD-pancreatoduodenectomy / Robotic Whipple’s / OPD-open pancreatoduodenectomy / LPD-laparoscopic pancreatoduodenectomy / RPD-robotic pancreatoduodenectomy / pancreatic resection / pancreatic cancer

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