Is robotic pancreaticoduodenectomy (PD) a valid alternative to open pancreaticoduodenectomy?

Abstract

In recent years, minimally invasive pancreatic surgery (MIPS) has become increasingly popular and is now considered an important part of pancreatic surgery practice. Nevertheless, MIPS is feasible and safe only in high-volume centres, with good training of surgeons and good patient selection. This commentary aims to focus on the role of MIPS, in particular robotic pancreaticoduodenectomy, highlighting the advantages of the robotic approach in terms of early postoperative recovery, reduced postoperative complications, and comparable oncological outcomes.

Keywords

Robotic pancreaticodudoenectomy / minimally invasive surgery / pancreatic tumours

References

[1] Korrel M, Jones LR, van Hilst J, et al.; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS). Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial.Lancet Reg Health Eur2023;31:100673 PMCID:PMC10339208

[2] Gagner M.Laparoscopic pylorus-preserving pancreatoduodenectomy.Surg Endosc1994;8:408-10

[3] Palanivelu C,Sabnis SC.Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours.Br J Surg2017;104:1443-50

[4] van Hilst J, de Rooij T, Bosscha K, et al.; Dutch Pancreatic Cancer Group. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial.Lancet Gastroenterol Hepatol2019;4:199-207

[5] Poves I,Morató O.Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial.Ann Surg2018;268:731-9

[6] de Graaf N, Emmen AMLH, Ramera M, et al.; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS). Minimally invasive versus open pancreatoduodenectomy for pancreatic and peri-ampullary neoplasm (DIPLOMA-2): study protocol for an international multicenter patient-blinded randomized controlled trial.Trials2023;24:665 PMCID:PMC10571285

[7] de Graaf N,Ramera M.Minimally invasive versus open pancreatoduodenectomy for resectable neoplasm (diploma-2).HPB2025;27:S1-2

[8] Klotz R,Kulu Y.Robotic versus open partial pancreatoduodenectomy (EUROPA): a randomised controlled stage 2b trial.Lancet Reg Health Eur2024;39:100864 PMCID:PMC10899052

[9] Liu Q,Gao Y.Effect of robotic versus open pancreaticoduodenectomy on postoperative length of hospital stay and complications for pancreatic head or periampullary tumours: a multicentre, open-label randomised controlled trial.Lancet Gastroenterol Hepatol2024;9:428-37

[10] Jin J,Chen M.Robotic versus open pancreatoduodenectomy for pancreatic and periampullary tumors (PORTAL): a study protocol for a multicenter phase III non-inferiority randomized controlled trial.Trials2021;22:954 PMCID:PMC8711152

[11] Jones LR, Zwart MJW, de Graaf N, et al.; International Consortium on Minimally Invasive Pancreatic Surgery (I-MIPS). Learning curve stratified outcomes after robotic pancreatoduodenectomy: international multicenter experience.Surgery2024;176:1721-9

[12] Wakabayashi T,Nie Y.Reduced pancreatic fistula rates and comprehensive cost analysis of robotic versus open pancreaticoduodenectomy.Surg Endosc2025;39:3921-9 PMCID:PMC12116723

[13] Li R,Chen W.Robotic pancreatoduodenectomy reduces grade B pancreatic fistula in patients with a small main pancreatic duct: a propensity score-matched study compared to laparoscopic pancreatoduodenectomy.Ann Med2025;57:2527357 PMCID:PMC12258235

[14] Fuji T,Umeda Y.Impact of robotic surgery on postoperative pancreatic fistula for high-risk pancreaticojejunostomy after pancreatoduodenectomy.Dig Surg2025;42:49-58

[15] Kim HE,Han Y.Evaluation of feasibility and clinical outcomes of robot-assisted pancreaticoduodenectomy after neoadjuvant treatment for patients with advanced pancreatic ductal adenocarcinoma: a retrospective propensity score-matched cohort study.Ann Surg Treat Res2025;109:61-70 PMCID:PMC12329137

[16] Zecchin Ferrara V,Toti F.Robotic vascular resection in pancreatic ductal adenocarcinoma: a systematic review.J Clin Med2024;13:2000 PMCID:PMC11012275